Elena Valeryevna Kormaskova, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD158199 Issued in OR

Practice address

2050 Progress Way
Woodburn, OR 97071-9764

Phone

(503) 981-5348

Fax

(503) 467-5588

NPI assigned

May 3, 2012

Last updated

Oct 12, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• Direct secure messaging: elena.kormaskova.wpc@direct.wvp.nextgenshare.com
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Woodburn Pediatric Clinic

  • Primary Care Clinic/Center
  • Woodburn, OR
  • NPI 1154741916
  NPD (past)
• Woodburn Pediatric Clinic LLP

  • Pediatrics Physician
  • Woodburn, OR
  • NPI 1790969624
  NPD (past)

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

{
    "created_epoch": "1336003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697068800000",
    "number": "1720347206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 PROGRESS WAY",
            "city": "WOODBURN",
            "state": "OR",
            "postal_code": "970719764",
            "telephone_number": "503-981-5348",
            "fax_number": "503-467-5588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2050 PROGRESS WAY",
            "city": "WOODBURN",
            "state": "OR",
            "postal_code": "970719764",
            "telephone_number": "503-981-5348",
            "fax_number": "503-467-5588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORMASKOVA",
        "first_name": "ELENA",
        "middle_name": "VALERYEVNA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-03",
        "last_updated": "2023-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OR",
            "license": "MD158199",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500647564",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Steven Joseph Kempler, OTR/L
• Warren T Keyser, MD
• Dustin King
• John Alan King
• Gary Michael Kohl, PHARM D
• Tana Kornachuk, PA-C
• Mania Kupershtok
• Laboratory Corporation of America
• Lale RTH
• Tina Marie Leavenworth, LMT

• Pediatrics Physician in Woodburn, OR
• Providers in Woodburn, OR by specialty
• Pediatrics Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2023; 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.