Active NPI
Sergey Viktorovich Dergachev
- Massage Therapist
- Skokie, IL
National Provider Identifier
1841525656
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 227.004427
- Practice address
- 9933 Lawler Ave
Suite 520
Skokie, IL 60077-3703 - Phone
- (847) 763-1775
- NPI assigned
- Oct 12, 2009
- Last updated
- Oct 12, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 227.004427 | IL | Primary |
Addresses
Primary practice location
9933 Lawler Ave
Suite 520
Skokie, IL 60077-3703
Mailing address
1694 Hopi TRL
Wheeling, IL 60090-5126
Phone (847) 334-9110
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 227.004427 | IL | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1255305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1255305600000",
"number": "1841525656",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1694 HOPI TRL",
"city": "WHEELING",
"state": "IL",
"postal_code": "600905126",
"telephone_number": "847-334-9110"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9933 LAWLER AVE",
"address_2": "SUITE 520",
"city": "SKOKIE",
"state": "IL",
"postal_code": "600773703",
"telephone_number": "847-763-1775"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERGACHEV",
"first_name": "SERGEY",
"middle_name": "VIKTOROVICH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-10-12",
"last_updated": "2009-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "IL",
"license": "227.004427",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.