NPIMap

Individual provider Active NPI

Greta M Ivers, M.D.

  • Family Medicine Physician
  • Kailua Kona, HI
National Provider Identifier
1104911189
Registry record updated Dec 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD-18354 Issued in HI
Practice address
75-5751 Kuakini Hwy Ste 101a
Kailua Kona, HI 96740-1705
Phone
(808) 326-5629
NPI assigned
Oct 4, 2006
Last updated
Dec 2, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD-18354 HI Primary

Addresses

Primary practice location

75-5751 Kuakini Hwy Ste 101a
Kailua Kona, HI 96740-1705

Mailing address

75-5751 Kuakini Hwy Ste 203
Kailua Kona, HI 96740-1753
Phone (808) 326-5629

Other practice location 1

224 Haili Street
Bay Clinic Inc
Hilo, HI 96720-0000
Phone (808) 961-4071

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
I20230621003048 CO Practitioner - Family Practice 0143214056 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Valley Citizens' Foundation for Health Care IncGroup PAC ID 7517951536, shared by 4 NPIs, 25 clinicians
Valley-Wide Health Systems, Inc.Group PAC ID 5991609067, 42 clinicians

Practice addresses (Care Compare)

310 County Rd
14 Unit C
Del Norte, CO 81132-8759
Phone (719) 657-2418

310 County Rd
Suite 14
Del Norte, CO 81132

925 2ND Ave
Monte Vista, CO 81144-1432
Phone (719) 587-1001

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD-18354HIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Valley Citizens' Foundation for Health Care Inc CurrentSince Oct 1, 2023 Accepting new patients
Valley Citizens' Foundation for Health Care Inc CurrentSince Oct 1, 2023 Accepting new patients
Valley Citizens' Foundation for Health Care Inc Current Accepting new patients
Michigan Avenue Primary Care, S.C. Family Medicine Past Accepting new patients
Valley Citizens' Foundation for Health Care Inc Past Accepting new patients
Lutheran Hospital Association of the San Luis Valley Past Accepting new patients

Locations

310 County Road 14
Del Norte, CO 81132
Phone (719) 657-2510

310 County Road 14
Unit C
Del Norte, CO 81132
Phone (719) 657-2418

1033 2nd Ave
Monte Vista, CO 81144
Phone (719) 852-8827

Organizations & group practices 7

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.

Hospital & facility affiliations 5

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": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606867200000",
    "number": "1104911189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75-5751 KUAKINI HWY STE 203",
            "city": "KAILUA KONA",
            "state": "HI",
            "postal_code": "967401753",
            "telephone_number": "808-326-5629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75-5751 KUAKINI HWY STE 101A",
            "city": "KAILUA KONA",
            "state": "HI",
            "postal_code": "967401705",
            "telephone_number": "808-326-5629"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "224 Haili Street",
            "address_2": "Bay Clinic Inc",
            "address_purpose": "LOCATION",
            "city": "Hilo",
            "state": "HI",
            "postal_code": "967200000",
            "country_code": "US",
            "telephone_number": "808-961-4071",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IVERS",
        "first_name": "GRETA",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2020-12-02",
        "certification_date": "2020-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "HI",
            "license": "MD-18354",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kailua Kona, HI

Sources for this page

Verify at the official NPI Registry.