Individual provider Active NPI

Oleh Pankewycz, MD

  • Nephrology Physician
  • Las Vegas, NV
National Provider Identifier
1194792531
Registry record updated Dec 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
MD061181L Issued in PA
Practice address
901 Rancho LN.
Ste 250
Las Vegas, NV 89106
Phone
(702) 383-2224
Fax
(702) 383-3035
NPI assigned
Mar 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 221448 NY
Nephrology Physician 207RN0300X 21454 NV
Nephrology Physician 207RN0300X MD061181L PA Primary

Addresses

Primary practice location

901 Rancho LN.
Ste 250
Las Vegas, NV 89106

Mailing address

901 Rancho LN.
Ste 250
Las Vegas, NV 89106
Phone (702) 383-2224

Other identifiers 1

IdentifierTypeStateIssuer
02192309MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NV2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20060117000646 NY Practitioner - NephrologyPractitioner - Internal Medicine 8426072570 Reassigns benefits to 1 organization
I20211001002357 NV Practitioner - Nephrology 8426072570 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Columbia University College of Physicians and Surgeons, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Medical Center of Southern NevadaGroup PAC ID 7315934429, 388 clinicians

Practice addresses (Care Compare)

901 Rancho LN
Suite 250
Las Vegas, NV 89106-3835
Phone (702) 383-2224

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Department of Medicine Medical Service Group CurrentSince Apr 13, 2016 Accepting new patients
Department of Medicine Medical Serv GRP at Suny HLTH Sci Ctr Syr in Nephrology CurrentSince Apr 13, 2016 Accepting new patients
University Medical Center of Southern Nevada CurrentSince Oct 1, 2021 Accepting new patients
University Medical Center of Southern Nevada CurrentSince Oct 1, 2021 Accepting new patients

Locations

1800 W Charleston Blvd
Las Vegas, NV 89102
Phone (702) 207-8253

901 Rancho Ln
Ste 250
Las Vegas, NV 89106
Phone (702) 383-2224

750 E Adams St
Syracuse, NY 13210
Phone (315) 464-4363

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1141344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638835200000",
    "number": "1194792531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 RANCHO LN.",
            "address_2": "STE 250",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89106",
            "telephone_number": "702-383-2224",
            "fax_number": "702-383-3035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 RANCHO LN.",
            "address_2": "STE 250",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89106",
            "telephone_number": "702-383-2224",
            "fax_number": "702-383-3035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANKEWYCZ",
        "first_name": "OLEH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-03",
        "last_updated": "2021-12-07",
        "certification_date": "2021-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NY",
            "license": "221448",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NV",
            "license": "21454",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "PA",
            "license": "MD061181L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02192309",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.