Sergey Vladimirovich Ivanov, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

02005547A Issued in IN

Practice address

200 Mercy Circle
Oceanside, CA 92055

Phone

(760) 725-1288

NPI assigned

Mar 6, 2017

Last updated

Jun 14, 2024By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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.

• NH Camp Pendleton

  • Military General Acute Care Hospital
  • Camp Pendleton, CA
  • NPI 1386604387
  NPD (past)

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

{
    "created_epoch": "1488758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718323200000",
    "number": "1679013833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 MERCY CIRCLE",
            "city": "OCEANSIDE",
            "state": "CA",
            "postal_code": "920551006",
            "telephone_number": "760-725-1288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MERCY CIRCLE",
            "city": "OCEANSIDE",
            "state": "CA",
            "postal_code": "92055",
            "telephone_number": "760-725-1288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVANOV",
        "first_name": "SERGEY",
        "middle_name": "VLADIMIROVICH",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-03-06",
        "last_updated": "2024-06-14",
        "certification_date": "2024-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02005547A",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Linda Marie Isaak, RN 178098
• Valentin Isacescu, M.D.
• Adam Henry Isadore, M.D.
• Italian Maple Holdings, LLC (La Paloma Healthcare Center)
• James E Italiano, MD
• Jon Izzo
• J Walker Chiropractic (Dr Oceanside Chiropractic)
• J.E.M. Clinical Counseling, LLC
• Ja Precious Inc.
• Leanne D Jack, LVN

• Family Medicine Physician in Oceanside, CA
• Providers in Oceanside, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2024; 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.

Verify at the official NPI Registry.