Ivan Pivovarov, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

29030 Issued in AL

Practice address

279 Hughes Rd
Madison, AL 35758-1142

Phone

(256) 289-1733

NPI assigned

May 23, 2007

Last updated

Jul 21, 2022By the provider in NPPES

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

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.

Opted out of Medicare

Yes, effective Oct 1, 2025 through Oct 1, 2027

Specialty

Family Practice

Education

Other, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Huntsville Hospital Hospital, Huntsville, AL, CCN 010039

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Custom Family Care, LLC

  dba Custom Family Care

  • Family Medicine Physician
  • Madison, AL
  • NPI 1053839811
  Authorized official Same address or phone
• Valley Pain Clinic LLC

  • Pain Medicine (Anesthesiology) Physician
  • Decatur, AL
  • NPI 1386944239
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• The Health Care Authority of the City of Huntsville

  dba Huntsville Hospital

  • General Acute Care Hospital
  • Huntsville, AL
  • NPI 1447221056
  Care Compare affiliation

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1467662148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "279 HUGHES RD",
            "city": "MADISON",
            "state": "AL",
            "postal_code": "357581142",
            "telephone_number": "256-325-0480",
            "fax_number": "256-325-0481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "279 HUGHES RD",
            "city": "MADISON",
            "state": "AL",
            "postal_code": "357581142",
            "telephone_number": "256-289-1733"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1215 7th Street, SE",
            "address_2": "Suite G-300",
            "address_purpose": "LOCATION",
            "city": "Decatur",
            "state": "AL",
            "postal_code": "356013384",
            "country_code": "US",
            "telephone_number": "256-280-9335",
            "fax_number": "256-280-9337",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PIVOVAROV",
        "first_name": "IVAN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-23",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "29030",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pignataro Family Dentistry, PC
• Victoria Jeffcoat Pignataro, D.M.D.
• Tanya Jean Pike, ARNP
• Olivia C Pirtle, ALC
• Kristeona Sirah Pitts Watkins, ED.S, ALC
• Sydnai Pleasant, NP-C
• Colton Grady Plunkett, DPT
• Lori Pohly, ALC
• Alaina Callens Poole
• Porch & Yokley, D.M.D., P.C.

• Family Medicine Physician in Madison, AL
• Providers in Madison, AL by specialty
• Family Medicine Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• 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.