NPIMap

Individual provider Active NPI

Ivy M Andersen, MD

  • Sleep Medicine (Psychiatry & Neurology) Physician
  • La Crosse, WI
National Provider Identifier
1013064997
Registry record updated Apr 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sleep Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084S0012X
License
50652 Issued in WI
Practice address
1836 South Ave
La Crosse, WI 54601-5429
Phone
(608) 782-7300
NPI assigned
Jan 4, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2015

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Neurology Physician 2084N0400X 37293 IA
Neurology Physician 2084N0400X 50652 WI
Sleep Medicine (Psychiatry & Neurology) Physician 2084S0012X 50652 WI Primary
Sleep Medicine (Psychiatry & Neurology) Physician 2084S0012X 37293 IA

Addresses

Primary practice location

1836 South Ave
La Crosse, WI 54601-5429

Mailing address

1836 South Ave
La Crosse, WI 54601-5429
Phone (608) 782-7300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160505000234 CO Practitioner - Sleep MedicinePractitioner - PsychiatryPractitioner - Neurology 8527155050 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Sleep MedicineAlso: Neurology, Psychiatry
Education
University of Iowa, RJ & L Carver College of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Banner Health Physicians Colorado LLCGroup PAC ID 8921273038, 278 clinicians

Practice addresses (Care Compare)

1801 16TH St
Greeley, CO 80631-5154
Phone (970) 810-4121

1900 Boise Ave
Loveland, CO 80538-5004

2010 16TH St
Suite a
Greeley, CO 80631-5188
Phone (970) 810-4475

4700 Lady Moon Dr
Fort Collins, CO 80528-4426

Hospital & facility affiliations

  • Banner North Colorado Medical Center Hospital, Greeley, CO, CCN 060001

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
37293IAMDSleep Medicine (Psychiatry & Neurology) Physician
50652WIMDSleep Medicine (Psychiatry & Neurology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Health Physicians Colorado LLC CurrentSince Aug 1, 2025 Accepting new patients
Elan Sleep LLC Sleep Medicine CurrentSince Feb 1, 2025 Accepting new patients
Banner Health Physicians Colorado LLC CurrentSince Aug 1, 2025 Accepting new patients
Banner Health Physicians Colorado LLC Past Accepting new patients

Locations

4895 Riverbend Rd
Ste A
Boulder, CO 80301

4700 Lady Moon Dr
Ste C1
Fort Collins, CO 80528
Phone (970) 821-4500

1801 16th St
Ste C2B
Greeley, CO 80631
Phone (970) 810-4121

1630 Dry Creek Dr
Ste 200
Longmont, CO 80503

1630 Dry Creek Dr
Longmont, CO 80503

1900 Boise Ave
Ste 220
Loveland, CO 80538
Phone (970) 203-2120

9399 Crown Crest Blvd
Ste 350
Parker, CO 80138
Phone (303) 269-4188

Networks

  • NM HMO C-SNP
  • CO HMO
  • CO HMO D-SNP
  • devoted network organization-a4751131-f16f-4e82-8f2b-b08e66379a7a

Organizations & group practices 4

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.

Hospital & facility affiliations 12

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

NPI Registry JSON

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428624000000",
    "number": "1013064997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1836 SOUTH AVE",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546015429",
            "telephone_number": "608-782-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1836 SOUTH AVE",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546015429",
            "telephone_number": "608-782-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSEN",
        "first_name": "IVY",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-04",
        "last_updated": "2015-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "IA",
            "license": "37293",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "WI",
            "license": "50652",
            "primary": false
        },
        {
            "code": "2084S0012X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Sleep Medicine",
            "state": "WI",
            "license": "50652",
            "primary": true
        },
        {
            "code": "2084S0012X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Sleep Medicine",
            "state": "IA",
            "license": "37293",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Crosse, WI

Sources for this page

Verify at the official NPI Registry.