Michael Travis Ivan, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

12382175-1204 Issued in UT

Practice address

4403 Harrison Blvd Ste 700a
Ogden, UT 84403-3295

Phone

(801) 387-5300

Fax

(801) 387-5333

NPI assigned

Mar 27, 2020

Last updated

Apr 13, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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 UT

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.

Enrollment records 1

Specialty

Family Practice

Education

Kansas City University of Med & Biosciences, College of Osteo Med, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ihc Health Services IncGroup PAC ID 1850209420, shared by 68 NPIs, 3,948 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Intermountain Health Sevier Valley Hospital Hospital, Richfield, UT, CCN 460026

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Ihc Health Services Inc

  dba IMED Physicians Billing

  • Multi-Specialty Clinic/Center
  • Murray, UT
  • NPI 1629260880

  Family Medicine

  Medicare reassignment NPD
• Ihc Health Services Inc

  • Multi-Specialty Clinic/Center
  • Sandy, UT
  • NPI 1942325154
  Medicare reassignment NPD
• Ihc Health Services Inc

  dba Orem Community Hospital Physicians

  • Multi-Specialty Clinic/Center
  • Orem, UT
  • NPI 1588601124
  NPD
• Ihc Health Services Inc

  dba Utah Valley Ear Nose Throat

  • Otolaryngology Physician
  • Provo, UT
  • NPI 1831390038
  NPD
• Ihc Health Services, Inc.

  dba St George Adolescent Partial Hospitalization

  • Psychiatry Physician
  • St George, UT
  • NPI 1023843844
  NPD

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

• Ihc Health Services, Inc.

  dba Intermountain Health Sevier Valley Hospital

  • General Acute Care Hospital
  • Richfield, UT
  • NPI 1336256775
  Care Compare affiliation

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

{
    "created_epoch": "1585267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681344000000",
    "number": "1528695533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1149 23RD ST",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844011906",
            "telephone_number": "801-687-8510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4403 HARRISON BLVD STE 700A",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844033295",
            "telephone_number": "801-387-5300",
            "fax_number": "801-387-5333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVAN",
        "first_name": "MICHAEL",
        "middle_name": "TRAVIS",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-27",
        "last_updated": "2023-04-13",
        "certification_date": "2023-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "12382175-1204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Josephine S Ishaya, DNP
• Ismile at Ogden Dental PLLC
• Marcella Israel Rocha, MD
• Melissa Arlene Ita'Aehau, PT
• Ashlee Ito
• Clint G. Iverson, D.M.D.
• Mary Jean Iverson, CPCI
• Richard Blaine Iverson, D.O.
• Jessica Ivy
• Kyle Jackman, D.O

• Family Medicine Physician in Ogden, UT
• Providers in Ogden, UT by specialty
• Family Medicine Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2023; 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.