Ivna Medical Group LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

2016039188 Issued in MO

Legal business name

IVNA MEDICAL GROUP LLC

Practice address

4811 S Arrowhead Dr
Independence, MO 64055-6981

Phone

(816) 356-4600

Fax

(816) 353-7296

NPI assigned

Jan 23, 2007

Organization subpart

No

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

Authorized official

Name

Vikranth Anneboina

Title

Member

Phone

(816) 356-4600

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Stadium Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Pallavi Ponna, RPH

  • Pharmacist
  • Independence, MO
  • NPI 1104569516
  NPD

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493337600000",
    "number": "1013062090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4811 S ARROWHEAD DR",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "640556981",
            "telephone_number": "816-356-4600",
            "fax_number": "816-353-7296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4811 S ARROWHEAD DR",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "640556981",
            "telephone_number": "816-356-4600",
            "fax_number": "816-353-7296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVNA MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2017-04-28",
        "status": "A",
        "authorized_official_last_name": "ANNEBOINA",
        "authorized_official_first_name": "VIKRANTH",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "816-356-4600"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MO",
            "license": "2016039188",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2166225",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "605454206",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stadium Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Inspire Counseling and Wellness LLC
• Interim Healthcare of Kansas City, Inc.
• Jessica M Isaacson, M.S., CCC-SLP
• Jill C Isabel, MA, PLPC
• Atef F Israel, MD
• Annie Jack
• Sara Jackaway, MA PLPC
• David Shawn Jackel, APRN, FNP-BC
• Jackie Ransom, LPC, LLC
• Jackley Chiropractic Inc.

• Community/Retail Pharmacy in Independence, MO
• Providers in Independence, MO by specialty
• Community/Retail Pharmacy in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.