Individual provider Active NPI

Oleh J Wolowodiuk, M.D.

  • Emergency Medicine Physician
  • Fresno, CA
National Provider Identifier
1366635484
Registry record updated Oct 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
G47818 Issued in CA
Practice address
521 E Mariners Cir
Fresno, CA 93730-0848
Phone
(559) 434-1149
NPI assigned
Aug 22, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X G47818 CA Primary
Family Medicine Physician 207Q00000X G47818 CA

Addresses

Primary practice location

521 E Mariners Cir
Fresno, CA 93730-0848

Mailing address

521 E Mariners Cir
Fresno, CA 93730-0848
Phone (559) 434-1149

Other identifiers 1

IdentifierTypeStateIssuer
00G478180OtherCAMEDICAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20040831001334 CA Practitioner - Emergency Medicine 5092603456 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
47818CAMDGeneral Practice Dentistry
G47818CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America - California Emergency Medicine Current Accepting new patients
Cep America - California Emergency Medicine CurrentSince Jan 2, 2012 Accepting new patients
Cep America-California Emergency Medicine CurrentSince Jan 2, 2012 Accepting new patients
Fresno Community Hospital and Medical Center Past Accepting new patients

Locations

2755 Herndon Ave
Clovis, CA 93611
Phone (559) 323-4000

2100 Powell St
Ste 900
Emeryville, CA 94608
Phone (510) 350-2777

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

372 W Cypress Ave
Reedley, CA 93654
Phone (559) 391-3110

4445 Magnolia Ave
Riverside, CA 92501
Phone (800) 498-7156

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": "1187740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475798400000",
    "number": "1366635484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "521 E MARINERS CIR",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937300848",
            "telephone_number": "559-434-1149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "521 E MARINERS CIR",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937300848",
            "telephone_number": "559-434-1149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLOWODIUK",
        "first_name": "OLEH",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-22",
        "last_updated": "2016-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "G47818",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G47818",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL",
            "identifier": "00G478180",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

Verify at the official NPI Registry.