Active NPI
Jascha Marchuk
- Student in an Organized Health Care Education/Training Program
- Minneapolis, MN
National Provider Identifier
1669863494
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 606 24TH Ave S
Suite 200
Minneapolis, MN 55454-1455 - Phone
- (612) 625-2495
- NPI assigned
- Feb 16, 2015
- 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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
606 24TH Ave S
Suite 200
Minneapolis, MN 55454-1455
Mailing address
413 Southbrook Cir
Mankato, MN 56001-4783
Phone (218) 929-1599
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160916000312 | MN | Order and Referring Only - Dentist | 8022304104 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1424044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1424044800000",
"number": "1669863494",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "413 SOUTHBROOK CIR",
"city": "MANKATO",
"state": "MN",
"postal_code": "560014783",
"telephone_number": "218-929-1599"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "606 24TH AVE S",
"address_2": "SUITE 200",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554541455",
"telephone_number": "612-625-2495"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARCHUK",
"first_name": "JASCHA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-02-16",
"last_updated": "2015-02-16",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2015; 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.