Allison Marie Ivan, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-08982 Issued in NC

Practice address

645 Amalia St NE
Concord, NC 28025-2434

Phone

(704) 295-3255

Fax

(704) 295-7791

NPI assigned

Sep 3, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: aivan19274@direct.ceenta.com

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

{
    "created_epoch": "1567468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619568000000",
    "number": "1093363095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "645 AMALIA ST NE",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252434",
            "telephone_number": "704-295-3255",
            "fax_number": "704-295-7791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "645 AMALIA ST NE",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252434",
            "telephone_number": "704-295-3255",
            "fax_number": "704-295-7791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVAN",
        "first_name": "ALLISON",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-03",
        "last_updated": "2021-04-28",
        "certification_date": "2021-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-08982",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "aivan19274@direct.ceenta.com",
            "affiliation": "N",
            "address_1": "645 Amalia St NE",
            "city": "Concord",
            "state": "NC",
            "country_code": "US",
            "postal_code": "280252434",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Physician Assistant in Concord, NC
• Providers in Concord, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.