Individual provider Active NPI

Ian Hover, PT, MPT

  • Physical Therapist
  • Peoria, AZ
National Provider Identifier
1366445033
Registry record updated Nov 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
6688 Issued in AZ
Practice address
8240 W. Cactus Road
Peoria, AZ 85381
Phone
(623) 878-9696
Fax
(623) 776-0668
NPI assigned
May 24, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 9, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 6688 AZ Primary

Addresses

Primary practice location

8240 W. Cactus Road
Peoria, AZ 85381

Mailing address

8240 W. Cactus Rd.
Peoria, AZ 85381
Phone (623) 878-9696

Other identifiers 1

IdentifierTypeStateIssuer
926157MedicaidAZ

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050401000928 AZ Practitioner - Physical Therapist in Private Practice 1456308311 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Modern Sports Medicine LLCGroup PAC ID 6800228479, 40 clinicians

Practice addresses (Care Compare)

8240 W Cactus Rd
Peoria, AZ 85381-5231
Phone (480) 306-6627

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6688AZMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Modern Sports Medicine LLC Physical Therapist CurrentSince Dec 15, 2022 Accepting new patients
Oakeson Physical Therapy Physical Therapist CurrentSince Jul 31, 2006 Accepting new patients
Modern Sports Medicine LLC CurrentSince Dec 15, 2022 Accepting new patients

Locations

5590 W Chandler Blvd
Ste 4
Chandler, AZ 85226
Phone (480) 786-4969

8240 W Cactus Rd
Peoria, AZ 85381
Phone (623) 878-9696

10450 E Riggs Rd
Ste 104
Sun Lakes, AZ 85248
Phone (612) 888-5224

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1510185600000",
    "number": "1366445033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8240 W. CACTUS RD.",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "85381",
            "telephone_number": "623-878-9696",
            "fax_number": "623-776-0668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8240 W. CACTUS ROAD",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "85381",
            "telephone_number": "623-878-9696",
            "fax_number": "623-776-0668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOVER",
        "first_name": "IAN",
        "name_prefix": "Mr.",
        "credential": "PT, MPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-05-24",
        "last_updated": "2017-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "6688",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "926157",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2017; 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.