Active NPI
Andrey Yusupov, M.D.
- Diagnostic Radiology Physician
- Fort Wainwright, AK
National Provider Identifier
1598059461
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- MD-17154
- Practice address
- 4076 Neely Rd
Fort Wainwright, AK 99703 - Phone
- (907) 361-5024
- NPI assigned
- Jun 7, 2011
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | MD-17154 | HI | Primary |
Addresses
Primary practice location
4076 Neely Rd
Fort Wainwright, AK 99703
Mailing address
2008B Southern Ave
Fairbanks, AK 99709-4237
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD-17154 | HI | MD | Diagnostic Radiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1307404800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529884800000",
"number": "1598059461",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2008B SOUTHERN AVE",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997094237"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4076 NEELY RD",
"city": "FORT WAINWRIGHT",
"state": "AK",
"postal_code": "99703",
"telephone_number": "907-361-5024"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YUSUPOV",
"first_name": "ANDREY",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-06-07",
"last_updated": "2018-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "HI",
"license": "MD-17154",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wainwright, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.