NPIMap

Individual provider Active NPI

Viktoriya V. Vladykina, MD

  • Hospitalist Physician
  • St Cloud, MN
National Provider Identifier
1780993345
Registry record updated Oct 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
55494 Issued in MN
Practice address
1200 Sixth Ave N
Centracare Clinic
St Cloud, MN 56303-2735
Phone
(320) 251-2700
Fax
(320) 240-3164
NPI assigned
Sep 30, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X PERMIT22871 MN
Hospitalist Physician 208M00000X 55494 MN Primary

Addresses

Primary practice location

1200 Sixth Ave N
Centracare Clinic
St Cloud, MN 56303-2735

Mailing address

1200 Sixth Ave N
Centracare Clinic
St Cloud, MN 56303-2735
Phone (320) 251-2700

Other identifiers 1

IdentifierTypeStateIssuer
1780993345MedicaidMN

Other names 1

  • Victozia Yetimova/Efimova Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20120904000277 MN Practitioner - Family PracticePractitioner - Emergency MedicinePractitioner - Hospitalist 7315194941 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Hospitalist
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centracare ClinicGroup PAC ID 2466363395, 800 clinicians

Practice addresses (Care Compare)

1200 6TH Ave N
Saint Cloud, MN 56303-2735

1200 6TH N Ave
Saint Cloud, MN 56303-2735
Phone (320) 252-5131

1406 6TH Ave N
St Cloud, MN 56303-1901

1406 6TH Ave No
St Cloud, MN 56303-1901

1900 Centracare Cir
Saint Cloud, MN 56303-5000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PERMIT22871MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Clinic CurrentSince Aug 5, 2013 Accepting new patients
Centracare Clinic Current Accepting new patients
Centracare Clinic Past Accepting new patients
St. Cloud Hospital Past Accepting new patients
Centracare Clinic Past Accepting new patients

Locations

111 17th Ave E
Alexandria, MN 56308
Phone (320) 762-1511

1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342

1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422

Interoperability endpoints

  • Direct secure messaging: vvladykina21060@direct.centracare.com

Organizations & group practices 5

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.

Hospital & facility affiliations 12

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

NPI Registry JSON

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

{
    "created_epoch": "1285804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1446163200000",
    "number": "1780993345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 SIXTH AVE N",
            "address_2": "CENTRACARE CLINIC",
            "city": "ST CLOUD",
            "state": "MN",
            "postal_code": "563032735",
            "telephone_number": "320-251-2700",
            "fax_number": "320-240-3164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 SIXTH AVE N",
            "address_2": "CENTRACARE CLINIC",
            "city": "ST CLOUD",
            "state": "MN",
            "postal_code": "563032735",
            "telephone_number": "320-251-2700",
            "fax_number": "320-240-3164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VLADYKINA",
        "first_name": "VIKTORIYA",
        "middle_name": "V.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-30",
        "last_updated": "2015-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "PERMIT22871",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MN",
            "license": "55494",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1780993345",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VICTOZIA",
            "last_name": "YETIMOVA/EFIMOVA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in St Cloud, MN

Sources for this page

Verify at the official NPI Registry.