Ivan John Christov Nicolov, M.D.

Primary specialty

Hospice and Palliative Medicine (Family Medicine) PhysicianTaxonomy code 207QH0002X

License

MD20060115 Issued in NM

Practice address

Bia Rte 125
Pine Hill, NM 87357

Phone

(505) 775-3271

Fax

(505) 775-3930

NPI assigned

May 18, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Ramah Navajo School Board, Inc

  dba Pine Hill Health Center

  • Federally Qualified Health Center (FQHC)
  • Pine Hill, NM
  • NPI 1619001849
  NPD (past)

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

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1649488255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "BIA RTE 125",
            "address_2": "310",
            "city": "PINE HILL",
            "state": "NM",
            "postal_code": "87357",
            "telephone_number": "505-775-3271",
            "fax_number": "505-775-3930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BIA RTE 125",
            "city": "PINE HILL",
            "state": "NM",
            "postal_code": "87357",
            "telephone_number": "505-775-3271",
            "fax_number": "505-775-3930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICOLOV",
        "first_name": "IVAN",
        "middle_name": "JOHN CHRISTOV",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QH0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": "NM",
            "license": "MD20060115",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Perry D Guthrie Jr., FNP-C
• Thomas Earl Himelick, PA-C, MMSC
• Lula Kelhoyouma
• Natasha Starr Martinez, LMHC
• Siamak Mollaei, PHARM.D
• Michael John Nolan, PA-C
• Pine Hill Health Center
• Ramah Navajo School Board, Inc (Pine Hill Health Center)
• Ramah Navajo School Board, Inc.
• Ramah Navajo School Board, Inc.

• Hospice and Palliative Medicine (Family Medicine) Physician in Pine Hill, NM
• Providers in Pine Hill, NM by specialty
• Hospice and Palliative Medicine (Family Medicine) Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.