Individual provider Active NPI

Vladimir Katyshev, M.D.

  • Neurocritical Care Physician
  • Phoenix, AZ
National Provider Identifier
1235417551
Registry record updated Mar 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurocritical Care PhysicianTaxonomy code 2084A2900X
License
53271 Issued in AZ
Practice address
250 E Dunlap Ave
Phoenix, AZ 85020-2825
Phone
(313) 745-4275
NPI assigned
Aug 3, 2011
Last updated
Mar 11, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 11, 2021

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 53271 AZ
Neurology Physician 2084N0400X 53271 AZ
Neurology Physician 2084N0400X 4301098616 MI
Vascular Neurology Physician 2084V0102X 53271 AZ
Neurocritical Care Physician 2084A2900X 53271 AZ Primary

Addresses

Primary practice location

250 E Dunlap Ave
Phoenix, AZ 85020-2825

Mailing address

111 E Dunlap Ave Ste 1-279
Phoenix, AZ 85020-7805
Phone (313) 745-4275

Other identifiers 1

IdentifierTypeStateIssuer
53271OtherAZARIZONA MEDICAL BOARD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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 1

Enrollment IDStateProvider typePAC IDDetails
I20170726002174 AZ Practitioner - Critical Care (Intensivists) 0143590950 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Critical Care (Intensivists)
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Neurocritical Care and Stroke of Arizona PLLCGroup PAC ID 0143493882, 5 clinicians

Practice addresses (Care Compare)

250 E Dunlap Ave
Phoenix, AZ 85020-2825
Phone (480) 331-6721

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
53271AZMDNeurocritical Care Physician
4301098616MIMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Neurocritical Care and Stroke of Arizona PLLC Critical Care Medicine CurrentSince Aug 1, 2017 Accepting new patients
The Metrohealth System Current Accepting new patients

Locations

111 E Dunlap Ave
Ste 1279
Phoenix, AZ 85020
Phone (480) 331-6721

250 E Dunlap Ave
Phoenix, AZ 85020
Phone (480) 331-6721

Interoperability endpoints

  • Direct secure messaging: vkatyshev116749@direct.metrohealth.org

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1312329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615420800000",
    "number": "1235417551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E DUNLAP AVE STE 1-279",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850207805",
            "telephone_number": "313-745-4275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 E DUNLAP AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850202825",
            "telephone_number": "313-745-4275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KATYSHEV",
        "first_name": "VLADIMIR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-08-03",
        "last_updated": "2021-03-11",
        "certification_date": "2021-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "AZ",
            "license": "53271",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "AZ",
            "license": "53271",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MI",
            "license": "4301098616",
            "primary": false
        },
        {
            "code": "2084V0102X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Vascular Neurology",
            "state": "AZ",
            "license": "53271",
            "primary": false
        },
        {
            "code": "2084A2900X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurocritical Care",
            "state": "AZ",
            "license": "53271",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARIZONA MEDICAL BOARD",
            "identifier": "53271",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.