Active NPI
Vladimir Nikolayevich Chernyshev
- Licensed Practical Nurse
- Portland, OR
National Provider Identifier
1366967879
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 201330050LPN
- Practice address
- 1130 NW 22ND Ave
Portland, OR 97210-2900 - Phone
- (503) 229-7137
- NPI assigned
- Aug 4, 2017
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 201330050LPN | OR | Primary |
Addresses
Primary practice location
1130 NW 22ND Ave
Portland, OR 97210-2900
Mailing address
1790 SE Bush St
Hillsboro, OR 97123-5017
Phone (503) 927-0884
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| YVA140152313 | Other | OR | REGENCE |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 201330050LPN | OR | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1501804800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1501804800000",
"number": "1366967879",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1790 SE BUSH ST",
"city": "HILLSBORO",
"state": "OR",
"postal_code": "971235017",
"telephone_number": "503-927-0884"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1130 NW 22ND AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972102900",
"telephone_number": "503-229-7137"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHERNYSHEV",
"first_name": "VLADIMIR",
"middle_name": "NIKOLAYEVICH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-08-04",
"last_updated": "2017-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "OR",
"license": "201330050LPN",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE",
"identifier": "YVA140152313",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.