Individual provider Active NPI

Ilya Yegudkin, DO

  • Student in an Organized Health Care Education/Training Program
  • Las Vegas, NV
National Provider Identifier
1750066593
Registry record updated Nov 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
License
SL2023 Issued in NV
Practice address
620 Shadow LN
Las Vegas, NV 89106-4194
Phone
(702) 388-4000
NPI assigned
Jun 20, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X SL2023 NV Primary
General Practice Physician 208D00000X DO3957 NV

Addresses

Primary practice location

620 Shadow LN
Las Vegas, NV 89106-4194

Mailing address

620 Shadow LN
Las Vegas, NV 89106-4194
Phone (702) 388-4000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
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

Enrollment IDStateProvider typePAC IDDetails
I20260129001868 NV Practitioner - General Practice 3678929452 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Touro Un Col of Osteopathic Medicine, Henderson, 2023
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

4055 Valley View LN
Suite 700
Dallas, TX 75244-4910

4055 Valley View LN
Suite 700
Dallas, TX 75244-5045

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
DO3957NVMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Signify Health Medical Associates, PLLC General Practice CurrentSince Jan 1, 2026 Accepting new patients

Locations

701 S Carson St
Ste 200
Carson City, NV 89701
Phone (617) 586-0958

4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1687219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763683200000",
    "number": "1750066593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 SHADOW LN",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891064194",
            "telephone_number": "702-388-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 SHADOW LN",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891064194",
            "telephone_number": "702-388-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YEGUDKIN",
        "first_name": "ILYA",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-20",
        "last_updated": "2025-11-21",
        "certification_date": "2025-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NV",
            "license": "SL2023",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NV",
            "license": "DO3957",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.