Active NPI
Martin Edward-John Bukovsky
- School Psychologist
- Yachats, OR
National Provider Identifier
1467124339
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- 190058892
- Practice address
- 155 NE Wax Myrtle Loop
Yachats, OR 97498-9427 - Phone
- (541) 351-5737
- NPI assigned
- Sep 29, 2021
- 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 |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 190058892 | CA | Primary |
Addresses
Primary practice location
155 NE Wax Myrtle Loop
Yachats, OR 97498-9427
Mailing address
PO Box 373
Yachats, OR 97498-0373
Phone (541) 351-5737
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 |
|---|---|---|---|
| 190058892 | CA | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1632873600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632873600000",
"number": "1467124339",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 373",
"city": "YACHATS",
"state": "OR",
"postal_code": "974980373",
"telephone_number": "541-351-5737"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "155 NE WAX MYRTLE LOOP",
"city": "YACHATS",
"state": "OR",
"postal_code": "974989427",
"telephone_number": "541-351-5737"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUKOVSKY",
"first_name": "MARTIN",
"middle_name": "EDWARD-JOHN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-09-29",
"last_updated": "2021-09-29",
"certification_date": "2021-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "CA",
"license": "190058892",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Yachats, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.