Active NPI
Sylvia Joy Zakusilov, NP
- Nurse Practitioner
- Elkhart, IN
National Provider Identifier
1174838684
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 28164101A
- Practice address
- 600 East Blvd
Elkhart, IN 46514-2483 - Phone
- (574) 523-3160
- NPI assigned
- Aug 10, 2010
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 28164101A | IN | Primary |
Addresses
Primary practice location
600 East Blvd
Elkhart, IN 46514-2483
Mailing address
PO Box 1241
South Bend, IN 46624-1241
Phone (885) 691-9888
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000672495 | Other | IN | ANTHEM |
| 200994950 | Medicaid | IN |
Other names 1
- Sylvia Joy Swan
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28164101A | IN | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pic Indiana PC | Current | Accepting new patients |
Locations
924 W Pike St
Goshen, IN 46526
Phone (574) 312-7056
Organizations & group practices 1
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.
-
- Urgent Care Clinic/Center
- Mishawaka, IN
- NPI 1942546890
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1281398400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1459814400000",
"number": "1174838684",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1241",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466241241",
"telephone_number": "885-691-9888"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 EAST BLVD",
"city": "ELKHART",
"state": "IN",
"postal_code": "465142483",
"telephone_number": "574-523-3160"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZAKUSILOV",
"first_name": "SYLVIA",
"middle_name": "JOY",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-08-10",
"last_updated": "2016-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "IN",
"license": "28164101A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000672495",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200994950",
"state": "IN"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "SYLVIA",
"last_name": "SWAN",
"middle_name": "JOY",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Elkhart, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.