Active NPI
Ihor Alexander Krynycky, M.D.
- Otolaryngology Physician
- Gaylord, MI
National Provider Identifier
1508897281
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 4301060478
- Practice address
- 829 N Center Ave
Suite 260
Gaylord, MI 49735-1595 - Phone
- (989) 731-7729
- Fax
- (989) 731-7983
- NPI assigned
- Jul 5, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 4301060478 | MI | Primary |
Addresses
Primary practice location
829 N Center Ave
Suite 260
Gaylord, MI 49735-1595
Mailing address
829 N Center Ave
Suite 260
Gaylord, MI 49735-1595
Phone (989) 731-7729
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DA0074 | Other | MEDICARE RR PROV ID | |
| 0406910201 | Other | MI | BCBSM PROVIDER NUMBER |
| 4605008 | Medicaid | MI | |
| 11383155 | Other | CAQH PROVIDER ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301060478 | MI | MD | Otolaryngology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152057600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1200614400000",
"number": "1508897281",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "829 N CENTER AVE",
"address_2": "SUITE 260",
"city": "GAYLORD",
"state": "MI",
"postal_code": "497351595",
"telephone_number": "989-731-7729",
"fax_number": "989-731-7983"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "829 N CENTER AVE",
"address_2": "SUITE 260",
"city": "GAYLORD",
"state": "MI",
"postal_code": "497351595",
"telephone_number": "989-731-7729",
"fax_number": "989-731-7983"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRYNYCKY",
"first_name": "IHOR",
"middle_name": "ALEXANDER",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-05",
"last_updated": "2008-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "MI",
"license": "4301060478",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RR PROV ID",
"identifier": "DA0074",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSM PROVIDER NUMBER",
"identifier": "0406910201",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4605008",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH PROVIDER ID",
"identifier": "11383155",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Gaylord, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2008; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.