Individual provider Active NPI

Yuri Y. Pushkin, DDS

  • General Practice Dentistry
  • Galena, OH
National Provider Identifier
1437154333
Registry record updated Jan 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
20369 Issued in OH
Practice address
3453 S Old 3C Rd
Galena, OH 43021-9795
Phone
(740) 965-1015
NPI assigned
Jun 16, 2005
Last updated
Jan 12, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 12, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 20369 OH Primary

Addresses

Primary practice location

3453 S Old 3C Rd
Galena, OH 43021-9795

Mailing address

3453 S Old 3C Rd
Galena, OH 43021-9795
Phone (740) 965-1015

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181017000909 OH Order and Referring Only - DentistPractitioner - Dentist 8527310721

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

LicenseStateTypeSpecialty
20369OHMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1118880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610409600000",
    "number": "1437154333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3453 S OLD 3C RD",
            "city": "GALENA",
            "state": "OH",
            "postal_code": "430219795",
            "telephone_number": "740-965-1015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3453 S OLD 3C RD",
            "city": "GALENA",
            "state": "OH",
            "postal_code": "430219795",
            "telephone_number": "740-965-1015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUSHKIN",
        "first_name": "YURI",
        "middle_name": "Y.",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-16",
        "last_updated": "2021-01-12",
        "certification_date": "2021-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "20369",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Galena, OH

Sources for this page

Verify at the official NPI Registry.