Andrew Ivanchenko MD PC

Primary specialty

SpecialistTaxonomy code 174400000X

License

036111777 Issued in IL

Legal business name

ANDREW IVANCHENKO MD PC

Practice address

985 S. Buffalo Grove Road
Buffalo Grove, IL 60089

Phone

(847) 681-1161

NPI assigned

Jun 7, 2007

Organization subpart

No

Name

Ms. Olesya Malloy

Title

Administrator

Phone

(847) 630-8340

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Andrew Ivanchenko, M.D.

  • Family Medicine Physician
  • Buffalo Grove, IL
  • NPI 1598767352

  IL

  Medicare reassignment NPD
• Galina Martirosyan, MPT

  • Physical Therapist
  • Skokie, IL
  • NPI 1841331113

  IL

  Medicare reassignment NPD
• Heather L Carlson, PT

  • Physical Therapist
  • Barrington, IL
  • NPI 1407064835
  NPD (past)

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

• Andrew Ivanchenko MD PC Former legal business name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 29, 2024.

{
    "created_epoch": "1181174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714348800000",
    "number": "1487857421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 MORAINE RD",
            "city": "HIGHLAND PARK",
            "state": "IL",
            "postal_code": "600351933",
            "telephone_number": "847-681-1161",
            "fax_number": "847-681-1171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "985 S. BUFFALO GROVE ROAD",
            "city": "BUFFALO GROVE",
            "state": "IL",
            "postal_code": "60089",
            "telephone_number": "847-681-1161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDREW IVANCHENKO MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-07",
        "last_updated": "2024-04-29",
        "certification_date": "2024-04-29",
        "status": "A",
        "authorized_official_last_name": "MALLOY",
        "authorized_official_first_name": "OLESYA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "847-630-8340",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "IL",
            "license": "036111777",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Andrew Ivanchenko MD PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• All providers in Buffalo Grove, IL
• Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.