Ivan Ivanov, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

RT003999 Issued in PA

Practice address

3200 S Water St
Upmc Sports Medicine
Pittsburgh, PA 15203-2307

Phone

(412) 432-3770

Fax

(412) 432-3774

NPI assigned

Mar 19, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1188432000000",
    "number": "1386768976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2855 ESPY AVE",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152162119",
            "telephone_number": "412-953-2960",
            "fax_number": "412-344-1771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 S WATER ST",
            "address_2": "UPMC SPORTS MEDICINE",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152032307",
            "telephone_number": "412-432-3770",
            "fax_number": "412-432-3774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVANOV",
        "first_name": "IVAN",
        "name_prefix": "Mr.",
        "credential": "ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-19",
        "last_updated": "2007-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "PA",
            "license": "RT003999",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jerome M Itzkoff, MD
• Benjamin Michael Ivan, DMD
• Rachel Ivancie, CNM, APRN, WHNP-BC
• Barbara Anne Ivanko, LCSW
• Emil Ivanov, MD
• Danielle April Nicole Iverson-Chapa, MA
• Melody Ives, CRNP
• Matthew Edward Iwaniec, M.A.
• Advait Iyer, DO
• Anahita Iyer

• Athletic Trainer in Pittsburgh, PA
• Providers in Pittsburgh, PA by specialty
• Athletic Trainer in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.