Ivan M Grynyshin, MD

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

MD423998 Issued in PA

Practice address

420 S Jackson St
Pottsville, PA 17901-3625

Phone

(570) 346-7797

NPI assigned

Nov 15, 2005

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

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in PA

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 1

Specialty

Anesthesiology

Education

University of Tennessee, HSC, College of Medicine, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Pottsville PA Endoscopy ASC LPGroup PAC ID 8325139595, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• The Pottsville PA Endoscopy ASC LP

  • Anesthesiology Physician
  • Pottsville, PA
  • NPI 1588849764

  Anesthesiology, PA

  Medicare reassignment Care Compare group NPD
• The Pottsville PA Endoscopy ASC LP

  • Ambulatory Surgical Clinic/Center
  • Pottsville, PA
  • NPI 1386833044
  Care Compare group NPD
• The Pottsville PA Endoscopy ASC, LLP (Crna)

  • Registered Nurse
  • Pottsville, PA
  • NPI 1841438264
  NPD (past)
• Roxbury Anesthesia, LLC

  • Anesthesiology Physician
  • Jersey City, NJ
  • NPI 1609926971

  Anesthesiology

  NPD (past)

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

{
    "created_epoch": "1132012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1240185600000",
    "number": "1124000369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 390",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185010390",
            "telephone_number": "570-346-7797",
            "fax_number": "570-342-9802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 S JACKSON ST",
            "city": "POTTSVILLE",
            "state": "PA",
            "postal_code": "179013625",
            "telephone_number": "570-346-7797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRYNYSHIN",
        "first_name": "IVAN",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-15",
        "last_updated": "2009-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "PA",
            "license": "MD423998",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1010799200001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00199596",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00159374",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Matthew S Griffin, P.T.
• Carlie Griffiths, CRNP
• Dawn-Marie Kelly Grose, D.C.
• Anthony Frank Grosso Jr., DO
• Michele Diane Grube, CRNA
• GSL Hospital
• Gslpg, Inc
• Thomas D Guastavino, MD
• Migdalia Azalia Gunoskey, LSW
• Maria Gustis

• All providers in Pottsville, PA
• Anesthesiology Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2009; 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.