Sergey Kashubin, NP-C

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

56339 Issued in ID

Practice address

10583 W Lake Hazel Rd
Boise, ID 83709-6326

Phone

(208) 302-5950

NPI assigned

Jul 6, 2019

Last updated

Nov 23, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 1, 2025 through Apr 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: skashubin1564287@direct.trinity-health.org

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.

• Evolution Chiropractic and Wellness

  • Chiropractor
  • Eagle, ID
  • NPI 1801554852
  NPD
• Functional Medicine of Idaho PC

  • Family Medicine Physician
  • Boise, ID
  • NPI 1336656040
  NPD (past)

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

{
    "created_epoch": "1562371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637625600000",
    "number": "1912569351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "947 E WINDING CREEK DR",
            "address_2": "STE 200",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836167231",
            "telephone_number": "208-302-5900",
            "fax_number": "208-302-5955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10583 W LAKE HAZEL RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837096326",
            "telephone_number": "208-302-5950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KASHUBIN",
        "first_name": "SERGEY",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-06",
        "last_updated": "2021-11-23",
        "certification_date": "2021-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "56339",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "ID",
            "license": "56339",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "admin@saltzerhealth.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "215 E Hawaii Ave",
            "city": "Nampa",
            "state": "ID",
            "country_code": "US",
            "postal_code": "836866011",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Camille Karwisch
• Laura Kasallis
• David Kasamis, PA-C
• Melinda Kaserman, LPC
• Sergei V Kashirny, MD
• Lauren Michelle Kasney, LMFT
• Margaret H Kaspar, MD
• Thomas Edward Kasprowicz, M.D.
• Elaina Kassel
• Dane Alan Kaster

• Primary Care Nurse Practitioner in Boise, ID
• Providers in Boise, ID by specialty
• Primary Care Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2021; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.