Active NPI
Nikolay Shalashov
- Community Health Worker
- Salem, OR
National Provider Identifier
1134585540
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 1539128
- Practice address
- 4485 Great Plains Dr NE
Salem, OR 97305-3681 - Phone
- (503) 428-2459
- NPI assigned
- Jan 14, 2016
- Sex
- Male
- Sole proprietor
- No
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 | 1539128 | OR | Primary |
Addresses
Primary practice location
4485 Great Plains Dr NE
Salem, OR 97305-3681
Mailing address
4485 Great Plains Dr NE
Salem, OR 97305
Phone (503) 428-2459
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 |
|---|---|---|---|
| 1539128 | OR | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1452729600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1452729600000",
"number": "1134585540",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4485 GREAT PLAINS DR NE",
"city": "SALEM",
"state": "OR",
"postal_code": "97305",
"telephone_number": "503-428-2459"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4485 GREAT PLAINS DR NE",
"city": "SALEM",
"state": "OR",
"postal_code": "973053681",
"telephone_number": "503-428-2459"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHALASHOV",
"first_name": "NIKOLAY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-01-14",
"last_updated": "2016-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "OR",
"license": "1539128",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salem, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 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.