Phouvieng Sivilay

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

39902 Issued in MN

Practice address

10452 Spyglass Dr
Eden Prairie, MN 55347-4656

Phone

(612) 508-8743

NPI assigned

Oct 18, 2023

Last updated

Oct 18, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Chimney Pines LLC

  • Assisted Living Facility
  • Eden Prairie, MN
  • NPI 1003683913
  NPD Authorized official
• Angel Home Care

  • Home Health Agency
  • Eden Prairie, MN
  • NPI 1285935643
  Authorized official Same address or phone

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

{
    "created_epoch": "1697587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697587200000",
    "number": "1245012715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10428 SHELTER GRV",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553474855",
            "telephone_number": "612-508-8743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10452 SPYGLASS DR",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553474656",
            "telephone_number": "612-508-8743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIVILAY",
        "first_name": "PHOUVIENG",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-10-18",
        "last_updated": "2023-10-18",
        "certification_date": "2023-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": "39902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Silvercrest Properties, LLC
• Emenet Sime
• David J. Simmer, D.C.
• Dominique Marie Simonton, O.D.
• Jill Melisa Sinda, MS PT
• Kriss Regan Sjostrom, LPCC
• Mikala Skelton
• Jason W Skiles, DO
• Skin Physicians PA
• Skinner Counseling LLC

• Assisted Living Facility in Eden Prairie, MN
• Providers in Eden Prairie, MN by specialty
• Assisted Living Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.