Active NPI
Viacheslav Khomutets
- Massage Therapist
- Streamwood, IL
National Provider Identifier
1568286268
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 227.023390
- Practice address
- 500 S Bartlett Rd
Streamwood, IL 60107-1310 - Phone
- (352) 910-0628
- NPI assigned
- Nov 11, 2024
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MA104038 | FL | |
| Massage Therapist | 225700000X | 227.023390 | IL | Primary |
Addresses
Primary practice location
500 S Bartlett Rd
Streamwood, IL 60107-1310
Mailing address
1460 Fairlane Dr Apt 215
Schaumburg, IL 60193-3530
Phone (352) 910-0628
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 |
|---|---|---|---|
| MA104038 | FL | MD | Massage Therapist |
| 227.023390 | IL | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1731283200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731283200000",
"number": "1568286268",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1460 FAIRLANE DR APT 215",
"city": "SCHAUMBURG",
"state": "IL",
"postal_code": "601933530",
"telephone_number": "352-910-0628"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 S BARTLETT RD",
"city": "STREAMWOOD",
"state": "IL",
"postal_code": "601071310",
"telephone_number": "352-910-0628"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHOMUTETS",
"first_name": "VIACHESLAV",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-11-11",
"last_updated": "2024-11-11",
"certification_date": "2024-11-11",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "FL",
"license": "MA104038",
"primary": false
},
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "IL",
"license": "227.023390",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Streamwood, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.