Vitaliy Viktor Kostyukevich, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA22576 Issued in CA

Practice address

4112 E Commerce Way
Sacramento, CA 95834-9680

Phone

(916) 396-2929

NPI assigned

Jan 28, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA, HI2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299
  Medicare reassignment NPD
• Cep America - California

  dba Vituity

  • Emergency Medicine Physician
  • San Francisco, CA
  • NPI 1023063542
  Medicare reassignment
• Hawaii Permanente Medical Group Inc

  • Health Maintenance Organization
  • Honolulu, HI
  • NPI 1710945969
  Medicare reassignment
• Cep America - California

  dba Vituity

  • Emergency Medicine Physician
  • Roseville, CA
  • NPI 1346265154
  NPD
• Permanente Medical Group, Inc

  • Clinical Medical Laboratory
  • San Jose, CA
  • NPI 1497971584
  NPD

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

{
    "created_epoch": "1359331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641168000000",
    "number": "1376881227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4112 E COMMERCE WAY",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958349680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4112 E COMMERCE WAY",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958349680",
            "telephone_number": "916-396-2929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSTYUKEVICH",
        "first_name": "VITALIY",
        "middle_name": "VIKTOR",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-01-28",
        "last_updated": "2022-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA22576",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "6600 Bruceville Rd",
            "city": "Sacramento",
            "state": "CA",
            "country_code": "US",
            "postal_code": "958234671",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Samantha Lynne Kosobud
• Gerald Kost, M.D., PH.D.
• Tyler Kristine Koster, MSW, ASW
• Quiana Kostiuk-Thompson
• Jane E Kostka, LCSW
• Jean K Kotal, OTR/L
• Christine Kotcher
• Lydia Kotey, RN
• Sadhana Samir Kothari, DDS
• Arjun Chaman Kotwal, DO

• Physician Assistant in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.