Ivan E Montalvo-Otano, MD

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

License

218973 Issued in NY

Practice address

830 Washington St
Watertown, NY 13601-4034

Phone

(315) 785-4313

Fax

(315) 779-5114

NPI assigned

Jun 21, 2006

Last updated

Apr 17, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Pain Management Medical Services LLC

  • Interventional Pain Medicine Physician
  • San Juan, PR
  • NPI 1962120030
  NPD Authorized official
• Jefferson Anesthesiologist Services PC

  • Anesthesiology Physician
  • Watertown, NY
  • NPI 1508818014
  Medicare reassignment
• Samaritan Medical Center

  • General Acute Care Hospital
  • Watertown, NY
  • NPI 1598713745
  Medicare reassignment
• Brooklyn Anesthesia Medical Group, PLLC

  • Specialist
  • Brooklyn, NY
  • NPI 1679524813
  NPD (past)
• University Physicians of Brooklyn, Inc

  dba Downstate Health Physicians

  • Anesthesiology Physician
  • Brooklyn, NY
  • NPI 1104878180
  NPD (past)
• University Physicians of Brooklyn, Inc.

  dba Downstate Health Physicians

  • Surgery Physician
  • Brooklyn, NY
  • NPI 1538116082
  NPD (past)

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713312000000",
    "number": "1184660789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 WASHINGTON ST",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136014034",
            "telephone_number": "315-785-4313",
            "fax_number": "315-779-5114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 WASHINGTON ST",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136014034",
            "telephone_number": "315-785-4313",
            "fax_number": "315-779-5114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTALVO-OTANO",
        "first_name": "IVAN",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-21",
        "last_updated": "2024-04-17",
        "certification_date": "2024-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NY",
            "license": "218973",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NY",
            "license": "218973",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02098319",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James Louis Monaco, MASTERS DEGREE LCSW
• Jessica R Monaghan
• Leanna Money-Yacono
• Michelle Lynn Monnat
• Sherri Monnat, RN
• Nickole Anne Montana, LPN
• Jaime Nicole Montanaro, OTR/L
• Virginia Lopez Montenegro, RN
• Laura Lyn Montondo, LPN
• Thomas U. Moody Sr., PHYSICIAN ASSISTANT

• Pain Medicine (Anesthesiology) Physician in Watertown, NY
• Providers in Watertown, NY by specialty
• Pain Medicine (Anesthesiology) Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2024; 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.