Active NPI
Ivan S Guevara, MD
- Pediatrics Physician
- Kennewick, WA
National Provider Identifier
1093815904
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- MD00040635
- Practice address
- 320 W 10TH Ave Ste 102
Kennewick, WA 99336-6302 - Phone
- (509) 221-5910
- Fax
- (509) 221-5912
- NPI assigned
- Sep 22, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | MD00040635 | WA | Primary |
Addresses
Primary practice location
320 W 10TH Ave Ste 102
Kennewick, WA 99336-6302
Mailing address
320 W 10TH Ave Ste 102
Kennewick, WA 99336-6302
Phone (509) 221-5910
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8345670 | Medicaid | WA |
Other names 1
- Ivan P Guevara
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD00040635 | WA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kennewick Public Hospital District | Past | Accepting new patients | |
| Kennewick Public Hospital District | Past | Accepting new patients |
Interoperability endpoints
- ivan.guevara.1@18485.direct.athenahealth.com
Organizations & group practices 2
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.
-
dba Kennewick General Hospital Home Health Care
- Home Health Agency
- Kennewick, WA
- NPI 1184797433
-
dba KGH Physician Clinics
- Multi-Specialty Clinic/Center
- Kennewick, WA
- NPI 1235257262
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158883200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1581292800000",
"number": "1093815904",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "320 W 10TH AVE STE 102",
"city": "KENNEWICK",
"state": "WA",
"postal_code": "993366302",
"telephone_number": "509-221-5910",
"fax_number": "509-221-5912"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "320 W 10TH AVE STE 102",
"city": "KENNEWICK",
"state": "WA",
"postal_code": "993366302",
"telephone_number": "509-221-5910",
"fax_number": "509-221-5912"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUEVARA",
"first_name": "IVAN",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-22",
"last_updated": "2020-02-10",
"certification_date": "2020-02-10",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "WA",
"license": "MD00040635",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8345670",
"state": "WA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "IVAN",
"last_name": "GUEVARA",
"middle_name": "P",
"credential": "MD",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Kennewick, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.