Mark Ivantsov, PHD

Primary specialty

PharmacistTaxonomy code 183500000X

License

2022044966 Issued in MO

Practice address

860 Arnold Commons Dr
Arnold, MO 63010-2164

Phone

(636) 282-4817

NPI assigned

Nov 14, 2022

Last updated

Nov 14, 2022By 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Alpine Home Health Agency, Inc.

  • Home Health Agency
  • Ballwin, MO
  • NPI 1982964086
  NPD

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

{
    "created_epoch": "1668384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668384000000",
    "number": "1033827688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5918 WOODBROOK DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631297219",
            "telephone_number": "314-607-5056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "860 ARNOLD COMMONS DR",
            "city": "ARNOLD",
            "state": "MO",
            "postal_code": "630102164",
            "telephone_number": "636-282-4817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVANTSOV",
        "first_name": "MARK",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-11-14",
        "last_updated": "2022-11-14",
        "certification_date": "2022-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MO",
            "license": "2022044966",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Krista Hutson
• Ignited Home Care LLC
• Ignited Transit LLC
• Arlene Invencion, DMD
• Sara Irovic, PT, DPT
• Ryleigh Jackson
• Valerie Jackson, OTR/L
• Rebecca Jadwisiak, DO
• Abigail Jasper, OTR/L
• Nancy Jane Jasper, FNP-C

• Pharmacist in Arnold, MO
• Providers in Arnold, MO by specialty
• Pharmacist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.