NPIMap

Individual provider Active NPI

John G Ivanoff, M.D.

  • Interventional Cardiology Physician
  • Tulsa, OK
National Provider Identifier
1497725857
Registry record updated Jun 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
19125 Issued in OK
Practice address
10505 E 91St St
Suite 208
Tulsa, OK 74133-5801
Phone
(918) 494-8500
NPI assigned
Jan 26, 2006
Last updated
Jun 13, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Cardiology Physician 207RI0011X 19125 OK Primary

Addresses

Primary practice location

10505 E 91St St
Suite 208
Tulsa, OK 74133-5801

Mailing address

6600 S Yale Ave
Suite 1400
Tulsa, OK 74136-3347
Phone (918) 488-6001

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080318000608 OK Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology) 8426951443 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Interventional Cardiology
Education
Medical College of Pennsylvania, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Warren Clinic IncGroup PAC ID 8820900293, 787 clinicians
Saint Francis Hospital, Inc.Group PAC ID 9537061171, 58 clinicians

Practice addresses (Care Compare)

6161 S Yale Ave
Tulsa, OK 74136-1902
Phone (918) 502-4720

6600 S Yale Ave
Suite 1400
Tulsa, OK 74136-3331
Phone (918) 488-6000

715 N Foreman St
Vinita, OK 74301-1422
Phone (918) 256-8731

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
19125OKMDInterventional Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Francis Hospital Muskogee Inc CurrentSince Sep 1, 2020 Accepting new patients
Integris Cardiovascular Physicians LLC Past Accepting new patients
South Tulsa Medical Group LLC Past Accepting new patients
Oklahoma Heart Inc PastSince Aug 1, 1996 Accepting new patients

Locations

300 Rockefeller Dr
Muskogee, OK 74401
Phone (918) 682-5501

10501 E 91st St
Tulsa, OK 74133
Phone (918) 307-6000

6161 S Yale Ave
Tulsa, OK 74136
Phone (918) 494-2200

6655 S Yale Ave
Tulsa, OK 74136
Phone (918) 481-4000

735 N Foreman St
Vinita, OK 74301
Phone (918) 256-7551

Interoperability endpoints

  • FHIR API: https://epicproxy.ardenthealth.com/fhir/OHI/api/FHIR/R4
  • Direct secure messaging: jivanoff7800@direct.saintfrancis.com

Organizations & group practices 9

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.

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1138233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560384000000",
    "number": "1497725857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 S YALE AVE",
            "address_2": "SUITE 1400",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741363347",
            "telephone_number": "918-488-6001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10505 E 91ST ST",
            "address_2": "SUITE 208",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741335801",
            "telephone_number": "918-494-8500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVANOFF",
        "first_name": "JOHN",
        "middle_name": "G",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-26",
        "last_updated": "2019-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "OK",
            "license": "19125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.