NPIMap

Individual provider Active NPI

Andrey Zholnerovich, FNP

  • Family Nurse Practitioner
  • Salem, OR
National Provider Identifier
1689496218
Registry record updated Oct 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
10034392 Issued in OR
Practice address
610 Hawthorne Ave SE Ste 110
Salem, OR 97301-5378
Phone
(503) 814-4440
Fax
(503) 814-4444
NPI assigned
Oct 25, 2024
Last updated
Oct 25, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 10034392 OR Primary

Addresses

Primary practice location

610 Hawthorne Ave SE Ste 110
Salem, OR 97301-5378

Mailing address

610 Hawthorne Ave SE Ste 110
Salem, OR 97301-5378
Phone (503) 814-4440

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241111002893 OR Practitioner - Nurse Practitioner 2860926060 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oregon Heart Center PCGroup PAC ID 1951438472, 12 clinicians

Practice addresses (Care Compare)

610 Hawthorne Ave SE
Suite 110
Salem, OR 97301-5378
Phone (503) 814-4440

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Oregon Heart Center PC CurrentSince Jan 1, 2025 Accepting new patients

Locations

610 Hawthorne Ave SE
Ste 110
Salem, OR 97301
Phone (503) 561-7160

Interoperability endpoints

  • Direct secure messaging: azholnerovich106727@direct.salemhealth.org
  • Direct secure messaging: azholnerovich777419@oc.providencedirect.org

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 21

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1729814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729814400000",
    "number": "1689496218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 HAWTHORNE AVE SE STE 110",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973015378",
            "telephone_number": "503-814-4440",
            "fax_number": "503-814-4444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 HAWTHORNE AVE SE STE 110",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973015378",
            "telephone_number": "503-814-4440",
            "fax_number": "503-814-4444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZHOLNEROVICH",
        "first_name": "ANDREY",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-10-25",
        "last_updated": "2024-10-25",
        "certification_date": "2024-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "10034392",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

Verify at the official NPI Registry.