Michael Mstislavovich Ivanitsky, MD

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

MD22589 Issued in OR

Practice address

940 E 5TH St
Coquille, OR 97423-1699

Phone

(541) 396-3111

Fax

(541) 396-8135

NPI assigned

Jul 21, 2006

Last updated

Sep 4, 2020By 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 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

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

Specialty

Orthopedic Surgery

Education

Mayo Medical School, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lower Umpqua Hospital DistrictGroup PAC ID 6800703562, 42 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Lower Umpqua Hospital District Hospital, Reedsport, OR, CCN 381311
• Bay Area Hospital Hospital, Coos Bay, OR, CCN 380090

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• WA PPO C-SNP
• devoted network organization-83621310-88c0-4660-8f8d-b8ea8f4dc04e

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/5c5c3b5c-6128-40bc-b71b-102ccb82d7e7/

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.

• Lower Umpqua Hospital District

  • Critical Access Hospital
  • Reedsport, OR
  • NPI 1003874819
  Medicare reassignment Care Compare group NPD
• North Bend Medical Center Inc

  dba NBMC-Main

  • Multi-Specialty Clinic/Center
  • Coos Bay, OR
  • NPI 1407812365
  Medicare reassignment NPD
• Lower Umpqua Hospital District

  dba Lower Umpqua Hospital Pharmacy

  • Community/Retail Pharmacy
  • Reedsport, OR
  • NPI 1336334754
  NPD
• Lower Umpqua Hospital District

  • Medicare Defined Swing Bed Hospital Unit
  • Reedsport, OR
  • NPI 1063460095
  NPD (past)
• Lower Umpqua Hospital District

  • Land Ambulance
  • Reedsport, OR
  • NPI 1528195054
  NPD (past)
• Lower Umpqua Hospital District

  • Critical Access Hospital
  • Reedsport, OR
  • NPI 1538249081
  NPD (past)

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

• Bay Area Hospital District

  dba Bay Area Hospital

  • General Acute Care Hospital
  • Coos Bay, OR
  • NPI 1225016561
  Care Compare affiliation
• Lower Umpqua Hospital District

  • Critical Access Hospital
  • Reedsport, OR
  • NPI 1003874819
  Care Compare affiliation

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599177600000",
    "number": "1003837410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "940 E 5TH ST",
            "city": "COQUILLE",
            "state": "OR",
            "postal_code": "974231666",
            "telephone_number": "541-396-3111",
            "fax_number": "541-396-8135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "940 E 5TH ST",
            "city": "COQUILLE",
            "state": "OR",
            "postal_code": "974231699",
            "telephone_number": "541-396-3111",
            "fax_number": "541-396-8135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVANITSKY",
        "first_name": "MICHAEL",
        "middle_name": "MSTISLAVOVICH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-21",
        "last_updated": "2020-09-04",
        "certification_date": "2020-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "OR",
            "license": "MD22589",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "288121",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan Jane Hohmann
• Megan M Holland, MD
• Linda Hoover
• Patrick Huang, PHARMD
• Rand Glen Hunt, M.S.
• Nicole Marie Janke, FNP-C
• Joshua Michael Jeppesen
• Candie Marie Keller, MSN, APRN, NP-C
• Nancy Keller, MD
• Amanda Krantz, FNP-C

• Orthopaedic Surgery Physician in Coquille, OR
• Providers in Coquille, OR by specialty
• Orthopaedic Surgery Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.