NPIMap

Individual provider Active NPI

Ivanka A Vassileva, MD

  • Family Medicine Physician
  • Lawton, OK
National Provider Identifier
1295729929
Registry record updated Feb 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
22970 Issued in OK
Practice address
4411 W Gore Blvd
Ste B10
Lawton, OK 73505-5977
Phone
(580) 354-9600
Fax
(580) 354-9621
NPI assigned
Sep 8, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 9, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 22970 OK Primary

Addresses

Primary practice location

4411 W Gore Blvd
Ste B10
Lawton, OK 73505-5977

Mailing address

4411 W Gore Blvd
Ste B10
Lawton, OK 73505-5977
Phone (580) 354-9600

Other identifiers 1

IdentifierTypeStateIssuer
200055900AMedicaidOK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050811000342 OK Practitioner - Family Practice 5092757393 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4411 W Gore Blvd
Lawton, OK 73505-5977
Phone (580) 354-9600

Hospital & facility affiliations

  • Carter Healthcare of Southwest Oklahoma, LLC Home health agency, Lawton, OK, CCN 377636
  • Memorial Home Health Home health agency, Lawton, OK, CCN 377070
  • Angels Care Home Health of Oklahoma Home health agency, Oklahoma City, OK, CCN 377447
  • Elara Caring Xxiv Home health agency, Lawton, OK, CCN 377660
  • Memorial Health Hospital, Lawton, OK, CCN 370056
  • Southwestern Medical Center Hospital, Lawton, OK, CCN 370097

Merit-based Incentive Payment System (MIPS)

Final score
94.85 of 100Reported as individual
Quality
100
Improvement activities
40
Cost
82.84

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Ivanka a. Vassileva, M.D., P.C. Family Medicine Current Accepting new patients
Southwestern Medical Center, LLC CurrentSince May 27, 2005 Accepting new patients
Comanche County Hospital Authority CurrentSince Aug 1, 2005 Accepting new patients
Summit Medical Center Past Accepting new patients

Locations

4411 W Gore Blvd
Ste B10
Lawton, OK 73505
Phone (580) 353-0909

Organizations & group practices 4

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.

Hospital & facility affiliations 8

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": "1126137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328745600000",
    "number": "1295729929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4411 W GORE BLVD",
            "address_2": "STE B10",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735055977",
            "telephone_number": "580-354-9600",
            "fax_number": "580-354-9621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4411 W GORE BLVD",
            "address_2": "STE B10",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735055977",
            "telephone_number": "580-354-9600",
            "fax_number": "580-354-9621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VASSILEVA",
        "first_name": "IVANKA",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-09-08",
        "last_updated": "2012-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "22970",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200055900A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawton, OK

Sources for this page

Verify at the official NPI Registry.