Roman Ivankiv

Primary specialty

Foot Surgery PodiatristTaxonomy code 213ES0131X

License

PO4215 Issued in FL

Practice address

1740 Tree Blvd Ste 112
St Augustine, FL 32084-5720

Phone

(904) 826-1900

Fax

(904) 826-1920

NPI assigned

Sep 22, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

Barry University School of Podiatric Medicine, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Coastal Foot and Ankle Wellness Center LLCGroup PAC ID 9537204151, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Brooks Rehabilitation Home Health Home health agency, Palatka, FL, CCN 109754
• HCA Florida Putnam Hospital Hospital, Palatka, FL, CCN 100232
• Flagler Hospital Hospital, Saint Augustine, FL, CCN 100090

Merit-based Incentive Payment System (MIPS)

Final score

82.08 of 100Reported as individual

Quality

65

Promoting interoperability

92

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rivankiv743509@direct.shands.ufl.edu

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Coastal Foot & Ankle Wellness Center LLC

  • Foot & Ankle Surgery Podiatrist
  • St Augustine, FL
  • NPI 1972834760

  FL, Foot Surgery

  Medicare reassignment Care Compare group NPD

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

• Brooks Home Care Advantage, Inc

  • Home Health Agency
  • Palatka, FL
  • NPI 1255671129
  Care Compare affiliation
• Flagler Hospital Inc

  • General Acute Care Hospital
  • St Augustine, FL
  • NPI 1144211020

  Hospital

  Care Compare affiliation
• Flagler Hospital, Inc.

  • Urgent Care Clinic/Center
  • Saint Augustine, FL
  • NPI 1447527965

  Hospital

  Care Compare affiliation
• Putnam Community Medical Center of North Florida, LLC

  • General Acute Care Hospital
  • Palatka, FL
  • NPI 1487045100

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1474502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616889600000",
    "number": "1528517331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1740 TREE BLVD STE 112",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320845720",
            "telephone_number": "904-826-1900",
            "fax_number": "904-826-1920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1740 TREE BLVD STE 112",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320845720",
            "telephone_number": "904-826-1900",
            "fax_number": "904-826-1920"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "204 Luds Way",
            "address_purpose": "LOCATION",
            "city": "Dothan",
            "state": "AL",
            "postal_code": "363036350",
            "country_code": "US",
            "telephone_number": "334-678-7036",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IVANKIV",
        "first_name": "ROMAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-09-22",
        "last_updated": "2021-03-28",
        "certification_date": "2021-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0131X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot Surgery",
            "state": "AL",
            "license": "338",
            "primary": false
        },
        {
            "code": "213ES0131X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot Surgery",
            "state": "FL",
            "license": "PO4215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Island Family Pharmacy Inc
• Island Family Pharmacy Inc
• Islands Edge Dental, LLC
• Maryse Imbert Isma
• Anna IV, PA
• Margaret Iverson
• J Churchwell Counseling
• J Greg Dent M D & Associates P L
• J Mae Transportation
• Arlyn Rivera Jackson, MPT

• Foot Surgery Podiatrist in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Foot Surgery Podiatrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2021; 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.
• 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.