Ivan Bub, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD040616L Issued in PA

Practice address

2610 Keiser Blvd
Wyomissing, PA 19610-3333

Phone

(610) 775-3316

Fax

(610) 796-2962

NPI assigned

Sep 6, 2005

Last updated

Apr 11, 2011By 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 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• I Bub E Wittels & D Karabelnik PTRS

  • Family Medicine Physician
  • Wyomissing, PA
  • NPI 1952396343
  Authorized official Same address or phone

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

{
    "created_epoch": "1125964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1302480000000",
    "number": "1245224302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2610 KEISER BLVD",
            "city": "WYOMISSING",
            "state": "PA",
            "postal_code": "196103333",
            "telephone_number": "610-775-3316",
            "fax_number": "610-796-2962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2610 KEISER BLVD",
            "city": "WYOMISSING",
            "state": "PA",
            "postal_code": "196103333",
            "telephone_number": "610-775-3316",
            "fax_number": "610-796-2962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUB",
        "first_name": "IVAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-06",
        "last_updated": "2011-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD040616L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0012539300007",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paul Brockman, M.D.
• Deborah Ann Brown, DMD
• Linda E Brown, MD
• Deanna C Brugger
• Kathleen Marie Brumbach, PA-C
• Mary Susan Buckley-Hamm
• Christa Buckley
• Building Bridges Counseling, LLC
• Andrea J Bumbulsky
• Jason Thomas Bundy, M.D.

• Family Medicine Physician in Wyomissing, PA
• Providers in Wyomissing, PA by specialty
• Family Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2011; 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.