Individual provider Active NPI

Ekaterina Yankelevich, DDS

  • General Practice Dentistry
  • Columbus, OH
National Provider Identifier
1629189907
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
30-21298 Issued in OH
Practice address
1151 S High St
Columbus, OH 43206-3434
Phone
(614) 443-3400
Fax
(614) 443-4092
NPI assigned
Aug 31, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 30-21298 OH Primary

Addresses

Primary practice location

1151 S High St
Columbus, OH 43206-3434

Mailing address

4146 Riverside Dr
Columbus, OH 43220-4573
Phone (614) 459-3689

Other identifiers 1

IdentifierTypeStateIssuer
2255581MedicaidOH

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170109001290 OH Order and Referring Only - Other (Non-Physician) 2365723244

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
30-21298OHMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1629189907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4146 RIVERSIDE DR",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432204573",
            "telephone_number": "614-459-3689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1151 S HIGH ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432063434",
            "telephone_number": "614-443-3400",
            "fax_number": "614-443-4092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YANKELEVICH",
        "first_name": "EKATERINA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30-21298",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2255581",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

Verify at the official NPI Registry.