Individual provider Active NPI

Igor Z Abolnik, MD

  • Infectious Disease Physician
  • Rureka, CA
National Provider Identifier
1194783829
Registry record updated Jun 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
C145403 Issued in CA
Practice address
2280 Harrison Ave
Rureka, CA 95501-3305
Phone
(707) 443-9371
NPI assigned
May 3, 2006
Last updated
Jun 26, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease Physician 207RI0200X 3106671205 UT
Infectious Disease Physician 207RI0200X C145403 CA Primary

Addresses

Primary practice location

2280 Harrison Ave
Rureka, CA 95501-3305

Mailing address

1055 N 500 W
Provo, UT 84604-3305
Phone (801) 374-2367

Other practice location 1

1055 N 500 W
Suite 202 Bldg C
Provo, UT 84604-3305
Phone (801) 374-2367

Other identifiers 7

IdentifierTypeStateIssuer
589314OtherUTDMBA
870281028000MedicaidUT
55244OtherUTPEHP
107007723101OtherUTIHC HEALTHPLANS
440002649OtherUTPALMETTO GBA
QM0000035196OtherUTALTIUS
92-00030OtherUTUNITED HEALTHCARE

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address iabolnik1657409@oc.providencedirect.org
Direct Messaging Address iabolnik1657409@oc.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20161123001201 CA Practitioner - Infectious DiseasePractitioner - Internal Medicine 1153377833 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Infectious DiseaseAlso: Internal Medicine
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Practice addresses (Care Compare)

2280 Harrison Ave
Suite B
Eureka, CA 95501-3200
Phone (707) 443-9371

Hospital & facility affiliations

Organizations & group practices 1

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 3

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": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687737600000",
    "number": "1194783829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 N 500 W",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043305",
            "telephone_number": "801-374-2367",
            "fax_number": "801-429-8015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2280 HARRISON AVE",
            "city": "RUREKA",
            "state": "CA",
            "postal_code": "955013305",
            "telephone_number": "707-443-9371"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1055 N 500 W",
            "address_2": "Suite 202 Bldg C",
            "address_purpose": "LOCATION",
            "city": "Provo",
            "state": "UT",
            "postal_code": "846043305",
            "country_code": "US",
            "telephone_number": "801-374-2367",
            "fax_number": "801-429-8015",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ABOLNIK",
        "first_name": "IGOR",
        "middle_name": "Z",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-03",
        "last_updated": "2023-06-26",
        "certification_date": "2023-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "UT",
            "license": "3106671205",
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "CA",
            "license": "C145403",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMBA",
            "identifier": "589314",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "870281028000",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEHP",
            "identifier": "55244",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IHC HEALTHPLANS",
            "identifier": "107007723101",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA",
            "identifier": "440002649",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALTIUS",
            "identifier": "QM0000035196",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "92-00030",
            "state": "UT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "iabolnik1657409@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "2280 Harrison Ave Ste D",
            "city": "Eureka",
            "state": "CA",
            "country_code": "US",
            "postal_code": "955013200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "iabolnik1657409@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "2280 Harrison Ave Ste B",
            "city": "Eureka",
            "state": "CA",
            "country_code": "US",
            "postal_code": "955013200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Sources for this page

Verify at the official NPI Registry.