Igor M Bederov, NURSE PRACTITIONER

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

NP21555 Issued in CA

Practice address

262 Bonita LN
Foster City, CA 94404-1982

Phone

(650) 571-9090

NPI assigned

Jul 3, 2006

Last updated

Sep 5, 2013By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378339200000",
    "number": "1659301000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "262 BONITA LN",
            "city": "FOSTER CITY",
            "state": "CA",
            "postal_code": "944041982",
            "telephone_number": "650-571-9090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "262 BONITA LN",
            "city": "FOSTER CITY",
            "state": "CA",
            "postal_code": "944041982",
            "telephone_number": "650-571-9090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEDEROV",
        "first_name": "IGOR",
        "middle_name": "M",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-03",
        "last_updated": "2013-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "NP21555",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "RN586047",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Azadeh Azad, PHARMD
• Brandon Bakhtiar
• Aaron Ramos Balotro
• Barbara Baum
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• Michele Bell
• Casey Bermack, MD PHD
• Sumita Bhattacharya, RPH
• Ariana Gabriella Bickell
• Bianca Blanco, NP

• Family Nurse Practitioner in Foster City, CA
• Providers in Foster City, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.