Kaitlyn N Ivanov, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

4317 Issued in NH

Practice address

12 Portwalk PL
Portsmouth, NH 03801

Phone

(603) 431-4200

Fax

(603) 431-4202

NPI assigned

Aug 31, 2013

Sex

Female

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

Other names 1

• Kaitlyn N Hamel Former name

Medicare fee-for-service enrollment

Enrolled in NH

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2013

Medicare assignment

May accept Medicare assignment

Group practices

The Lovelace Institute for Spine and Sports Injuries IncorporatedGroup PAC ID 5294043832, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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 Lovelace Institute for Spine and Sports Injuries, Incorporated

  • Sports Physician Chiropractor
  • Portsmouth, NH
  • NPI 1073869830

  Physical Medicine & Rehabilitation

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1377907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567987200000",
    "number": "1275967713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 PORTWALK PL",
            "city": "PORTSMOUTH",
            "state": "NH",
            "postal_code": "038014086",
            "telephone_number": "603-431-4200",
            "fax_number": "603-431-4202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 PORTWALK PL",
            "city": "PORTSMOUTH",
            "state": "NH",
            "postal_code": "03801",
            "telephone_number": "603-431-4200",
            "fax_number": "603-431-4202"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "24 Stickney Ter Unit 5",
            "address_purpose": "LOCATION",
            "city": "Hampton",
            "state": "NH",
            "postal_code": "038424902",
            "country_code": "US",
            "telephone_number": "603-926-7369",
            "fax_number": "603-431-4200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12 Portwalk Pl",
            "address_purpose": "LOCATION",
            "city": "Portsmouth",
            "state": "NH",
            "postal_code": "03801",
            "country_code": "US",
            "telephone_number": "603-431-4200",
            "fax_number": "603-431-4202",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IVANOV",
        "first_name": "KAITLYN",
        "middle_name": "N",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-31",
        "last_updated": "2019-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NH",
            "license": "4317",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3116508",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAITLYN",
            "last_name": "HAMEL",
            "middle_name": "N",
            "credential": "PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jacqueline Rose Irzyk, APRN
• Island City Psych Services LLC
• Taylor Italia
• David J Itkin, MD
• John M Iudice, LICSW, MLADC
• Benjamin Michael Ivone, NP
• Tatiana Iwaseczko, D.C.
• Jabellanti PLLC
• Ashley Jackson
• Danielle Jackson

• Physical Therapist in Portsmouth, NH
• Providers in Portsmouth, NH by specialty
• Physical Therapist in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.