Individual provider Active NPI

Tatyana Rybakova

  • Child & Adolescent Psychiatry Physician
  • La Grange, KY
National Provider Identifier
1982615860
Registry record updated Apr 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
39344 Issued in KY
Practice address
2141 Spencer CT
La Grange, KY 40031-6742
Phone
(502) 589-8600
Fax
(502) 589-8771
NPI assigned
Aug 10, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatry Physician 2084P0804X 39344 KY Primary

Addresses

Primary practice location

2141 Spencer CT
La Grange, KY 40031-6742

Mailing address

101 W Muhammad Ali Blvd
Louisville, KY 40202-1954
Phone (502) 589-8600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20050823000293 KY Practitioner - Psychiatry 5496786196 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
39344KYMDChild & Adolescent Psychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Seven Counties Services, Inc. CurrentSince Mar 14, 2015 Accepting new patients

Locations

2141 Spencer Ct
Lagrange, KY 40031
Phone (502) 222-7201

530 S Jackson St
Louisville, KY 40202
Phone (502) 562-3000

10401 Linn Station Rd
Ste 100
Louisville, KY 40223

101 W Muhammad Ali Blvd
Louisville, KY 40202
Phone (502) 589-8615

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": "1155168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1397692800000",
    "number": "1982615860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 W MUHAMMAD ALI BLVD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402021954",
            "telephone_number": "502-589-8600",
            "fax_number": "502-589-8771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2141 SPENCER CT",
            "city": "LA GRANGE",
            "state": "KY",
            "postal_code": "400316742",
            "telephone_number": "502-589-8600",
            "fax_number": "502-589-8771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RYBAKOVA",
        "first_name": "TATYANA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-10",
        "last_updated": "2014-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "KY",
            "license": "39344",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Grange, KY

Sources for this page

Verify at the official NPI Registry.