Active NPI
Maksim Mokrushin, R.T.(MR)(ARRT)
- Magnetic Resonance Imaging Radiologic Technologist
- Elk Grove, CA
National Provider Identifier
1124989017
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Magnetic Resonance Imaging Radiologic Technologist
- License
- 1106772
- Practice address
- 5820 Villa Rosa Way
Elk Grove, CA 95758-6138 - Phone
- (916) 230-3437
- NPI assigned
- Nov 20, 2025
- 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 |
|---|---|---|---|---|
| Magnetic Resonance Imaging Radiologic Technologist | 2471M1202X | 1106772 | CA | Primary |
Addresses
Primary practice location
5820 Villa Rosa Way
Elk Grove, CA 95758-6138
Mailing address
5820 Villa Rosa Way
Elk Grove, CA 95758-6138
Phone (916) 230-3437
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 |
|---|---|---|---|
| 1106772 | CA | MD | Magnetic Resonance Imaging Radiologic Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1763596800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1764028800000",
"number": "1124989017",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5820 VILLA ROSA WAY",
"city": "ELK GROVE",
"state": "CA",
"postal_code": "957586138",
"telephone_number": "916-230-3437"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5820 VILLA ROSA WAY",
"city": "ELK GROVE",
"state": "CA",
"postal_code": "957586138",
"telephone_number": "916-230-3437"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOKRUSHIN",
"first_name": "MAKSIM",
"credential": "R.T.(MR)(ARRT)",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-11-20",
"last_updated": "2025-11-25",
"certification_date": "2025-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "2471M1202X",
"taxonomy_group": "",
"desc": "Radiologic Technologist, Magnetic Resonance Imaging",
"state": "CA",
"license": "1106772",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elk Grove, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.