Active NPI
Alex Ponomarenko, ARNP
- Primary Care Nurse Practitioner
- Spokane, WA
National Provider Identifier
1215009568
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128b(4) exclusion effective Jan 18, 2024.
Key facts
NPPES NPI Registry- Primary specialty
- Primary Care Nurse Practitioner
- License
- AP30007005
- Practice address
- 205 W Indiana Ave Ste B
Spokane, WA 99205-4763 - Phone
- (509) 326-6474
- NPI assigned
- Nov 14, 2006
- 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 |
|---|---|---|---|---|
| Primary Care Nurse Practitioner | 363LP2300X | AP30007005 | WA | Primary |
Addresses
Primary practice location
205 W Indiana Ave Ste B
Spokane, WA 99205-4763
Mailing address
205 W Indiana Ave Ste B
Spokane, WA 99205-4763
Phone (509) 326-6474
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
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP30007005 | WA | MD | Primary Care Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1215009568",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "205 W INDIANA AVE STE B",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992054763",
"telephone_number": "509-326-6474"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "205 W INDIANA AVE STE B",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992054763",
"telephone_number": "509-326-6474"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PONOMARENKO",
"first_name": "ALEX",
"credential": "ARNP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LP2300X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Primary Care",
"state": "WA",
"license": "AP30007005",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Spokane, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.