NPIMap

Individual provider Active NPI

Oleg Chebotarev, MD

  • Cardiovascular Disease Physician
  • Appleton, WI
National Provider Identifier
1780647552
Registry record updated Jan 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
21600 Issued in WI
Practice address
1818 N Meade St
Appleton, WI 54911-3454
Phone
(920) 731-8900
Fax
(920) 738-5369
NPI assigned
Apr 11, 2006
Last updated
Jan 12, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 21600 WI Primary
Cardiovascular Disease Physician 207RC0000X 25MA08401100 NJ

Addresses

Primary practice location

1818 N Meade St
Appleton, WI 54911-3454

Mailing address

2073 Klockner Rd
Hamilton, NJ 08690-3414
Phone (609) 584-1212

Other practice location 1

2073 Klockner Rd
Hamilton, NJ 08690-3414
Phone (609) 584-1212

Other identifiers 2

IdentifierTypeStateIssuer
0163431MedicaidNJ
223052989OtherTAX ID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, WI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20080801000451 NJ Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Advanced Heart Failure and Transplant Cardiology 4284626631 Reassigns benefits to 1 organization
I20211222001413 WI Practitioner - Cardiovascular Disease (Cardiology) 4284626631 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Thedacare, IncorporatedGroup PAC ID 1759294887, 654 clinicians

Practice addresses (Care Compare)

1818 N Meade St
Appleton, WI 54911-3454
Phone (920) 735-7645

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
21600WIMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Thedacare, Incorporated CurrentSince Dec 17, 2021 Accepting new patients
Princeton Healthcare Provider Group LLC CurrentSince Nov 1, 2015 Accepting new patients
Froedtert Manitowoc Medical Group, LLC CurrentSince Dec 2, 2024 Accepting new patients
Princeton Healthcare Provider Group LLC Cardiovascular Disease Current Accepting new patients
Princeton Healthcare Provider Group LLC Cardiovascular Disease CurrentSince Nov 1, 2015 Accepting new patients
Preferred Emergency Physicians Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Preferred Medical, PC Past Accepting new patients
Thedacare Medical Center - Shawano, Inc. Past Accepting new patients
Bluffton Health System LLC Past Accepting new patients
Care Group LLC Cardiovascular Disease Past Accepting new patients
Hamilton Infectious Disease Associates Past Accepting new patients

Locations

993 Lenox Dr
Ste 207
Lawrenceville, NJ 08648

1 Plainsboro Rd
Plainsboro, NJ 08536
Phone (609) 853-7000

5 Plainsboro Rd
Ste 300
Plainsboro, NJ 08536

1818 N Meade St
Appleton, WI 54911
Phone (920) 731-4101

4480 W Spencer St
Appleton, WI 54914
Phone (920) 738-4800

225 Memorial Dr
Berlin, WI 54923
Phone (920) 361-1313

2300 Western Ave
Manitowoc, WI 54220
Phone (920) 320-2011

130 2nd St
Neenah, WI 54956
Phone (920) 729-2063

1405 Mill St
New London, WI 54961
Phone (920) 531-2000

600 N Westhaven Dr
Oshkosh, WI 54904
Phone (920) 237-5000

1414 N Taylor Dr
Sheboygan, WI 53081
Phone (920) 320-2011

Interoperability endpoints

  • Direct secure messaging: ochebotarev317591@direct.thedacare.org
  • Direct secure messaging: ochebotarev850841@direct.froedtert.com

Organizations & group practices 12

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 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1144713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641945600000",
    "number": "1780647552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2073 KLOCKNER RD",
            "city": "HAMILTON",
            "state": "NJ",
            "postal_code": "086903414",
            "telephone_number": "609-584-1212",
            "fax_number": "609-584-0103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1818 N MEADE ST",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549113454",
            "telephone_number": "920-731-8900",
            "fax_number": "920-738-5369"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2073 Klockner Rd",
            "address_purpose": "LOCATION",
            "city": "Hamilton",
            "state": "NJ",
            "postal_code": "086903414",
            "country_code": "US",
            "telephone_number": "609-584-1212",
            "fax_number": "609-584-0103",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHEBOTAREV",
        "first_name": "OLEG",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-11",
        "last_updated": "2022-01-12",
        "certification_date": "2022-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "WI",
            "license": "21600",
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NJ",
            "license": "25MA08401100",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0163431",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "223052989",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.