BURAKOVSKIY, DPM PC (INTEGRATIVE FOOT AND ANKLE CENTERS OF WASHINGTON) - NPI NUMBER 1881777266

Summary

Provider Name: BURAKOVSKIY, DPM PC (INTEGRATIVE FOOT AND ANKLE CENTERS OF WASHINGTON)

NPI Number: 1881777266

Clasification: Podiatrist (213E00000X)

Address:
13030 121ST WAY NE
SUITE 204
KIRKLAND, WA
ZIP 98034

Phone Number: (425) 822-7426



Detailed Information

BURAKOVSKIY, DPM PC is a podiatrist in Kirkland, WA. The provider is a podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy. The assigned NPI number for this provider is 1881777266 and is registered as an organization entity type and is a multiple single specialty group.
The provider Is Doing Business As Integrative Foot And Ankle Centers Of Washington.

The provider's business address is:

13030 121ST WAY NE
SUITE 204
KIRKLAND, WA
ZIP 98034
Phone: (425) 822-7426
Fax: (425) 827-1717

The provider's authorized official is Mikhail Burakovskiy .
The authorized official title is Owner/provider and has the following contact phone number (425) 822-7426.

The enumeration date for this NPI number is 10/23/2006 and was last updated on 2/22/2013.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 213E00000X Podiatrist PO 00000808 WA No
2 213ES0103X Podiatrist Foot & Ankle Surgery PO00000808 WA Yes
3 213ES0103X Podiatrist Foot & Ankle Surgery PO60255094 WA No

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 G8861813 MEDICARE PIN WA
2 5833760004 MEDICARE NSC WA

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1881777266 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name BURAKOVSKIY, DPM PC The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider Other Organization Name INTEGRATIVE FOOT AND ANKLE CENTERS OF WASHINGTON Other name by which the organization provider is or has been known.
6 Provider Other Organization Name Type Code 3 Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
7 Provider First Line Business Practice Location Address 13030 121ST WAY NE The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
8 Provider Second Line Business Practice Location Address SUITE 204 The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
9 Provider Business Practice Location Address City Name KIRKLAND The city name in the location address of the provider being identified.
10 Provider Business Practice Location Address State Name WA The State code in the location of the provider being identified.
11 Provider Business Practice Location Address Postal Code 98034 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
12 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
13 Provider Business Practice Location Address Telephone Number 4258227426 The telephone number associated with the location address of the provider being identified.
14 Provider Business Practice Location Address Fax Number 4258271717 The fax number associated with the location address of the provider being identified.
15 Provider Enumeration Date 10/23/2006 The date the provider was assigned a unique identifier (assigned an NPI).
16 Last Update Date 2/22/2013 The date that a record was last updated or changed.
17 Authorized Official Last Name BURAKOVSKIY The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
18 Authorized Official First Name MIKHAIL The first name of the authorized official.
19 Authorized Official Title or Position OWNER/PROVIDER The title or position of the authorized official.
20 Authorized Official Telephone Number 4258227426 The 10-position telephone number of the authorized official.
21 Healthcare Provider Taxonomy Code 1 213E00000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
22 Provider License Number 1 PO 00000808 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
23 Provider License Number State Code 1 WA The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
24 Healthcare Provider Primary Taxonomy Switch 1 N
25 Healthcare Provider Taxonomy Code 2 213ES0103X
26 Provider License Number 2 PO00000808 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
27 Provider License Number State Code 2 WA The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
28 Healthcare Provider Primary Taxonomy Switch 2 Y
29 Healthcare Provider Taxonomy Code 3 213ES0103X
30 Provider License Number 3 PO60255094 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
31 Provider License Number State Code 3 WA The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
32 Healthcare Provider Primary Taxonomy Switch 3 N
33 Other Provider Identifier 1 G8861813 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
34 Other Provider Identifier Type Code 1 08 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
35 Other Provider Identifier State 1 WA
36 Other Provider Identifier 2 5833760004 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
37 Other Provider Identifier Type Code 2 07 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
38 Other Provider Identifier State 2 WA
39 Is Organization Subpart N
40 Authorized Official Name Prefix Text MR.
41 Authorized Official Credential Text DPM
42 Healthcare Provider Taxonomy Group 1 193400000X MULTIPLE SINGLE SPECIALTY GROUP
43 Healthcare Provider Taxonomy Group 2 193400000X MULTIPLE SINGLE SPECIALTY GROUP
44 Healthcare Provider Taxonomy Group 3 193400000X MULTIPLE SINGLE SPECIALTY GROUP

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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