Individual provider Active NPI

Ivan Rodrigo Kiryluk Putziger, M.D.

  • Psychiatry Physician
  • Vacaville, CA
National Provider Identifier
1346474921
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
A125612 Issued in CA
Practice address
1600 California Dr.
Vacaville, CA 95687
Phone
(707) 448-6841
NPI assigned
May 11, 2009
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Psychiatry Physician 2084P0800X A125612 CA Primary

Addresses

Primary practice location

1600 California Dr.
Vacaville, CA 95687

Mailing address

1600 California Dr.
Vacaville, CA 95687
Phone (707) 448-6841

Other names 1

  • Dr. Ivan Kiryluk Putziger Other name

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
I20170717003435 CA Practitioner - Psychiatry 7012287584 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Emory University School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Comprehensive Psychiatric Services a Medical GroupGroup PAC ID 0244329969, 74 clinicians

Practice addresses (Care Compare)

3100 Oak Rd
Suite 270
Walnut Creek, CA 94597-2078
Phone (925) 944-9711

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A125612CAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Yolo County Health and Human Services Agency Current Accepting new patients
Yolo County Health and Human Services Agency CurrentSince Jun 3, 2017 Accepting new patients
Comprehensive Psychiatric Services, a Medical Group Psychiatry CurrentSince Mar 1, 2020 Accepting new patients
Yolo County Health and Human Services Agency CurrentSince Jun 3, 2017 Accepting new patients

Locations

600 A St
Davis, CA 95616
Phone (530) 204-9467

611 Gateway Blvd
Ste 120
South San Francisco, CA 94080
Phone (650) 480-6023

611 Gateway Blvd
Ste 210
South San Francisco, CA 94080

3100 Oak Rd
Ste 270
Walnut Creek, CA 94597
Phone (925) 944-9711

500 Jefferson Blvd
Ste B150
West Sacramento, CA 95605
Phone (916) 375-6350

137 N Cottonwood St
Woodland, CA 95695
Phone (530) 666-8645

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1242000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1346474921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 CALIFORNIA DR.",
            "city": "VACAVILLE",
            "state": "CA",
            "postal_code": "95687",
            "telephone_number": "707-448-6841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 CALIFORNIA DR.",
            "city": "VACAVILLE",
            "state": "CA",
            "postal_code": "95687",
            "telephone_number": "707-448-6841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUTZIGER",
        "first_name": "IVAN",
        "middle_name": "RODRIGO KIRYLUK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-05-11",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A125612",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "IVAN",
            "last_name": "PUTZIGER",
            "middle_name": "KIRYLUK",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Vacaville, CA

Sources for this page

Verify at the official NPI Registry.