Individual provider Active NPI

Marina Olegovna Vyshutina, APRN-CNP

  • Gerontology Nurse Practitioner
  • Reno, NV
National Provider Identifier
1104510247
Registry record updated Sep 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
868219 Issued in NV
Practice address
1155 Mill St
Reno, NV 89502-1576
Phone
(775) 982-7878
Fax
(775) 982-4196
NPI assigned
Jun 2, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 868219 NV Primary

Addresses

Primary practice location

1155 Mill St
Reno, NV 89502-1576

Mailing address

1155 Mill St # Msm14
Reno, NV 89502-1576
Phone (775) 982-5262

Other practice location 1

10101 Double R Blvd
Reno, NV 89521-5931
Phone (775) 982-7878

Other practice location 2

1500 E 2nd St Ste 400
Reno, NV 89502-1198
Phone (775) 982-2400

Other practice location 3

1495 Mill St
Reno, NV 89502-1479
Phone (778) 982-7878

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231113001107 NV Practitioner - Nurse Practitioner 6901253939 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Care Services LLCGroup PAC ID 1951324318, 630 clinicians

Practice addresses (Care Compare)

1500 E 2ND St
Suite 400
Reno, NV 89502-1198
Phone (775) 982-2400

Hospital & facility affiliations

  • Renown Regional Medical Center Hospital, Reno, NV, CCN 290001

Merit-based Incentive Payment System (MIPS)

Final score
85.15 of 100Reported as group
Quality
79.09
Promoting interoperability
100
Improvement activities
40
Cost
71.43

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
868219NVMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Community Care Services LLC Current Accepting new patients
Community Care Services LLC CurrentSince Oct 1, 2023 Accepting new patients
Community Care Services LLC CurrentSince Oct 1, 2023 Accepting new patients

Locations

1500 E 2nd St
Ste 400
Reno, NV 89502

1495 Mill St
Reno, NV 89502
Phone (775) 982-3500

1155 Mill St
Reno, NV 89502
Phone (775) 982-7878

1155 Mill St
#14
Reno, NV 89502

10315 Professional Cir
Reno, NV 89521
Phone (775) 982-5860

Interoperability endpoints

  • Direct secure messaging: mvyshutina97665@direct.renown.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1685664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759190400000",
    "number": "1104510247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1155 MILL ST # MSM14",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895021576",
            "telephone_number": "775-982-5262",
            "fax_number": "775-982-5496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1155 MILL ST",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895021576",
            "telephone_number": "775-982-7878",
            "fax_number": "775-982-4196"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10101 Double R Blvd",
            "address_purpose": "LOCATION",
            "city": "Reno",
            "state": "NV",
            "postal_code": "895215931",
            "country_code": "US",
            "telephone_number": "775-982-7878",
            "fax_number": "775-982-4196",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1500 E 2nd St Ste 400",
            "address_purpose": "LOCATION",
            "city": "Reno",
            "state": "NV",
            "postal_code": "895021198",
            "country_code": "US",
            "telephone_number": "775-982-2400",
            "fax_number": "775-982-2410",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1495 Mill St",
            "address_purpose": "LOCATION",
            "city": "Reno",
            "state": "NV",
            "postal_code": "895021479",
            "country_code": "US",
            "telephone_number": "778-982-7878",
            "fax_number": "775-982-4196",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VYSHUTINA",
        "first_name": "MARINA",
        "middle_name": "OLEGOVNA",
        "name_prefix": "Ms.",
        "credential": "APRN-CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-02",
        "last_updated": "2025-09-30",
        "certification_date": "2025-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NV",
            "license": "868219",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Reno, NV

Sources for this page

Verify at the official NPI Registry.