Ivan Alexander Escudero, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

57355 Issued in KY

Practice address

912 Wallace Ave Ste 102
Leitchfield, KY 42754-2405

Phone

(270) 259-8888

Fax

(270) 259-8887

NPI assigned

May 6, 2020

Last updated

Apr 30, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1588723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714435200000",
    "number": "1427679935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23229",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423043229",
            "telephone_number": "270-688-1330",
            "fax_number": "270-688-1338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "912 WALLACE AVE STE 102",
            "city": "LEITCHFIELD",
            "state": "KY",
            "postal_code": "427542405",
            "telephone_number": "270-259-8888",
            "fax_number": "270-259-8887"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4201 St Antoine",
            "address_2": "UHC-9C",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "48201",
            "country_code": "US",
            "telephone_number": "313-745-5146",
            "fax_number": "313-966-0880",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1200 Barret Blvd",
            "address_purpose": "LOCATION",
            "city": "Henderson",
            "state": "KY",
            "postal_code": "424204950",
            "country_code": "US",
            "telephone_number": "270-844-8600",
            "fax_number": "270-844-8610",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "510 Ruby Dr",
            "address_purpose": "LOCATION",
            "city": "Madisonville",
            "state": "KY",
            "postal_code": "424312168",
            "country_code": "US",
            "telephone_number": "270-399-7900",
            "fax_number": "270-399-7910",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1895 Elizabethtown Rd",
            "address_purpose": "LOCATION",
            "city": "Leitchfield",
            "state": "KY",
            "postal_code": "427549138",
            "country_code": "US",
            "telephone_number": "270-230-0182",
            "fax_number": "270-230-1420",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2025 W Everly Brothers Blvd Ste 1A",
            "address_purpose": "LOCATION",
            "city": "Powderly",
            "state": "KY",
            "postal_code": "423675401",
            "country_code": "US",
            "telephone_number": "270-377-2600",
            "fax_number": "270-377-2610",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ESCUDERO",
        "first_name": "IVAN",
        "middle_name": "ALEXANDER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-05-06",
        "last_updated": "2024-04-30",
        "certification_date": "2024-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "57355",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "iescudero122359@direct.owensborohealth.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "iescudero122359@direct.owensborohealth.org",
            "address_1": "2025 W Everly Brothers Blvd Ste 1A",
            "city": "Powderly",
            "state": "KY",
            "country_code": "US",
            "postal_code": "423675401",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "iescudero122359@direct.owensborohealth.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "iescudero122359@direct.owensborohealth.org",
            "address_1": "510 Ruby Dr",
            "city": "Madisonville",
            "state": "KY",
            "country_code": "US",
            "postal_code": "424312168",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "iescudero122359@direct.owensborohealth.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "iescudero122359@direct.owensborohealth.org",
            "address_1": "1200 Barret Blvd",
            "city": "Henderson",
            "state": "KY",
            "country_code": "US",
            "postal_code": "424204950",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "iescudero122359@direct.owensborohealth.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "iescudero122359@direct.owensborohealth.org",
            "address_1": "1895 Elizabethtown Rd",
            "city": "Leitchfield",
            "state": "KY",
            "country_code": "US",
            "postal_code": "427549138",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "iescudero122359@direct.owensborohealth.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "iescudero122359@direct.owensborohealth.org",
            "address_1": "912 Wallace Ave Ste 102",
            "city": "Leitchfield",
            "state": "KY",
            "country_code": "US",
            "postal_code": "427542405",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Family Medicine Physician in Leitchfield, KY
• Providers in Leitchfield, KY by specialty
• Family Medicine Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2024; 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.