Active NPI
Pavel L Zaverukha
- Community Health Worker
- Meridian, ID
National Provider Identifier
1124561063
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- OTA-1036
- Practice address
- 4933 W Astonte St
Meridian, ID 83646-7101 - Phone
- (208) 392-8056
- NPI assigned
- Nov 26, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | OTA-1036 | ID | Primary |
Addresses
Primary practice location
4933 W Astonte St
Meridian, ID 83646-7101
Mailing address
4933 W Astonte St
Meridian, ID 83646-7101
Phone (208) 392-8056
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OTA-1036 | ID | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1480118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1480118400000",
"number": "1124561063",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4933 W ASTONTE ST",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836467101",
"telephone_number": "208-392-8056"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4933 W ASTONTE ST",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836467101",
"telephone_number": "208-392-8056"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZAVERUKHA",
"first_name": "PAVEL",
"middle_name": "L",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-11-26",
"last_updated": "2016-11-26",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "ID",
"license": "OTA-1036",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Meridian, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.