Ivan Petrovitch, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

0101245045 Issued in VA

Practice address

5121 S Cottonwood St
Murray, UT 84107-5701

Phone

(801) 507-7000

NPI assigned

Mar 5, 2007

Last updated

Oct 17, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in DC, UT, WA3 enrollments

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 3

Specialty

Diagnostic Radiology

Education

George Washington University School of Medicine, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northern Virginia Radiology Consultants, PLLCGroup PAC ID 8426117458, 27 clinicians

Tellica Imaging - Washington LLCGroup PAC ID 0648757393, 50 clinicians

Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Intermountain Medical Center Hospital, Murray, UT, CCN 460010
• Intermountain Health McKay-Dee Hospital Hospital, Ogden, UT, CCN 460004
• Intermountain Health Riverton Hospital Hospital, Riverton, UT, CCN 460058
• LDS Hospital Hospital, Salt Lake City, UT, CCN 460006
• Intermountain Health Alta View Hospital Hospital, Sandy, UT, CCN 460044

Merit-based Incentive Payment System (MIPS)

Final score

0 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

0

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ipetrovitch13980@direct.virginiahospitalcenter.net

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.

• Ihc Health Services Inc

  dba IMED Physicians Billing

  • Multi-Specialty Clinic/Center
  • Murray, UT
  • NPI 1629260880

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Northern Virginia Radiology Consultants, PLLC

  • Diagnostic Radiology Physician
  • Arlington, VA
  • NPI 1942463625

  DC

  Medicare reassignment Care Compare group NPD
• Tellica Imaging - Washington LLC

  • Radiology Clinic/Center
  • Tacoma, WA
  • NPI 1346093150

  Diagnostic Radiology

  Medicare reassignment Care Compare group NPD
• Tellica Imaging, LLC

  • Radiology Clinic/Center
  • Boise, ID
  • NPI 1760197198

  Diagnostic Radiology, UT

  Medicare reassignment NPD
• Ihc Health Services Inc

  dba Heber Valley Urgent Care

  • Multi-Specialty Clinic/Center
  • Heber City, UT
  • NPI 1235300914
  NPD
• Ihc Health Services, Inc.

  dba St George Adolescent Partial Hospitalization

  • Psychiatry Physician
  • St George, UT
  • NPI 1023843844
  NPD
• Ihc Health Services, Inc.

  dba Intermountain Cedar City Imaging Center MRI

  • Physiological Laboratory
  • Cedar City, UT
  • NPI 1538841747
  NPD
• Tellica Imaging, LLC

  • Physiological Laboratory
  • Ogden, UT
  • NPI 1144802802
  NPD
• Tellica Imaging, LLC

  • Physiological Laboratory
  • Bountiful, UT
  • NPI 1205554367
  NPD
• Tellica Imaging, LLC

  • Physiological Laboratory
  • Spanish Fork, UT
  • NPI 1518727734
  NPD
• Tellica Imaging, LLC

  • Physiological Laboratory
  • Salt Lake City, UT
  • NPI 1649998709
  NPD
• Tellica Imaging - Washington LLC

  • Radiology Clinic/Center
  • Auburn, WA
  • NPI 1215887401

  Diagnostic Radiology

  NPD

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

• Ihc Health Services Inc

  dba Intermountain Health Riverton Hospital

  • General Acute Care Hospital
  • Riverton, UT
  • NPI 1154551919
  Care Compare affiliation
• Ihc Health Services Inc

  dba Intermountain Health McKay-Dee Hospital

  • General Acute Care Hospital
  • Ogden, UT
  • NPI 1194749580
  Care Compare affiliation
• Ihc Health Services Inc

  dba Intermountain Health Alta View Hospital

  • General Acute Care Hospital
  • Sandy, UT
  • NPI 1962412486
  Care Compare affiliation
• Ihc Health Services, Inc.

  dba Intermountain Health Intermountain Medical Center

  • General Acute Care Hospital
  • Murray, UT
  • NPI 1043220650
  Care Compare affiliation
• Ihc Health Services, Inc.

  dba Intermountain Health LDS Hospital

  • General Acute Care Hospital
  • Salt Lake City, UT
  • NPI 1528078581
  Care Compare affiliation

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

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697500800000",
    "number": "1063541993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5217 S STATE ST STE 200",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841074812",
            "telephone_number": "801-313-4118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5121 S COTTONWOOD ST",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841075701",
            "telephone_number": "801-507-7000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1701 N George Mason Dr",
            "address_2": "Department of Radiology",
            "address_purpose": "LOCATION",
            "city": "Arlington",
            "state": "VA",
            "postal_code": "222053610",
            "country_code": "US",
            "telephone_number": "703-558-6730",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETROVITCH",
        "first_name": "IVAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-05",
        "last_updated": "2023-10-17",
        "certification_date": "2023-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "UT",
            "license": "13516848-1205",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "VA",
            "license": "0101245045",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kylee Peterson
• Leslie Peterson, ND
• Melissa Peterson
• Scott Robert Peterson, LCSW
• Shalese Peterson
• Priscila Fabiana Petry Bautista, DDS
• Sarah Pettyjohn, MD
• Bailey A Philipps
• Alexandria Phillips, FNP
• Charlee Marie Phillips

• Diagnostic Radiology Physician in Murray, UT
• Providers in Murray, UT by specialty
• Diagnostic Radiology Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2023; 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.