NPIMap

Individual provider Active NPI

Kateryna Ivanova, D.O.

  • Psychiatry Physician
  • Springfield, OH
National Provider Identifier
1699066373
Registry record updated Apr 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
34.011156 Issued in OH
Practice address
474 N Yellow Springs Street
Springfield, OH 45504-2938
Phone
(937) 399-9500
NPI assigned
Apr 28, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 26, 2019

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

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 63625 MN
Psychiatry Physician 2084P0800X Q3892 TX
Psychiatry Physician 2084P0800X 19-321 WI
Psychiatry Physician 2084P0800X OP60851495 WA
Psychiatry Physician 2084P0800X DO187158 OR
Psychiatry Physician 2084P0800X 20190133398 MO
Psychiatry Physician 2084P0800X 26323 MS
Psychiatry Physician 2084P0800X 34.011156 OH Primary

Addresses

Primary practice location

474 N Yellow Springs Street
Springfield, OH 45504-2938

Mailing address

807 West Ave
Austin, TX 78701-2207
Phone (888) 285-2269

Other practice location 1

6051 U S Highway 49
Hattiesburg, MS 39401-7201
Phone (601) 288-7000

Other practice location 2

1629 E Division St
River Falls, WI 54022-1571
Phone (715) 307-6000

Other practice location 3

1015 NW 22nd Ave
Portland, OR 97210-3025
Phone (503) 413-7711

Other practice location 4

2211 NE 139th St
Vancouver, WA 98686-2742
Phone (360) 487-1000

Other practice location 5

3500 Gaston Ave
Dallas, TX 75246-2088
Phone (214) 820-0111

Other practice location 6

700 S Park St
Madison, WI 53715-1830
Phone (608) 251-6100

Other practice location 7

2505 Mission Dr
Jefferson City, MO 65109-9508
Phone (573) 681-3000

Other practice location 8

4050 Coon Rapids Blvd NW
Coon Rapids, MN 55433-2522
Phone (763) 236-6000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, WA, OR, MO, WI5 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 5

Enrollment IDStateProvider typePAC IDDetails
I20150820010633 TX Practitioner - Psychiatry 5294964318 Reassigns benefits to 3 organizations
I20180702002286 WA Practitioner - Psychiatry 5294964318 Reassigns benefits to 1 organization
I20180702002901 OR Practitioner - Psychiatry 5294964318 Reassigns benefits to 1 organization
I20190520002824 MO Practitioner - Psychiatry 5294964318 Reassigns benefits to 3 organizations
I20190717002856 WI Practitioner - Psychiatry 5294964318 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of North Texas HSC, College of Osteopathic Med, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic Springfield CommunitiesGroup PAC ID 7416865845, shared by 26 NPIs, 1,121 clinicians

Practice addresses (Care Compare)

2115 S Fremont Ave
3050 MC Infectious Disease Whiteside
Springfield, MO 65804-2236
Phone (417) 820-3905

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.87 of 100Reported as group
Quality
70.15
Promoting interoperability
100
Improvement activities
40
Cost
72.75

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
63625MNMDPsychiatry Physician
20190133398MOMDPsychiatry Physician
26323MSMDPsychiatry Physician
34.011156OHMDPsychiatry Physician
DO187158ORMDPsychiatry Physician
Q3892TXMDPsychiatry Physician
19-321WIMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Clinics LLC CurrentSince Jun 1, 2018 Accepting new patients
Allina Health System CurrentSince Jun 8, 2019 Accepting new patients
Legacy Salmon Creek Hospital CurrentSince Jun 1, 2018 Accepting new patients
Mercy Hospital Springfield CurrentSince Feb 24, 2026 Accepting new patients
Legacy Clinics LLC CurrentSince Jun 1, 2018 Accepting new patients
Allina Health System Current Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Feb 24, 2026 Accepting new patients
Mercy Hospital Springfield CurrentSince Feb 24, 2026 Accepting new patients
Tri-County Clinical CurrentSince Sep 19, 2024 Accepting new patients
Legacy Salmon Creek Hospital CurrentSince Jun 1, 2018 Accepting new patients
Health and Human Services Commission Psychiatry Current Accepting new patients
University of Texas Southwestern Medical Center at Dallas Current Accepting new patients
University of Texas Southwestern Medical Center at Dallas Psychiatry CurrentSince Jul 15, 2015 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Feb 24, 2026 Accepting new patients
The University of Texas Southwestern Medical Center at Dallas CurrentSince Jul 15, 2015 Accepting new patients
Health and Human Services Commission CurrentSince Sep 1, 2017 Accepting new patients
Tri-County Clinical Current Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Feb 24, 2026 Accepting new patients
Mercy Hospital Springfield Past Accepting new patients

Locations

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

1015 NW 22nd Ave
Portland, OR 97210
Phone (503) 413-7582

2801 N Gantenbein Ave
Portland, OR 97227
Phone (503) 413-2200

1130 NW 22nd Ave
Ste 220
Portland, OR 97210
Phone (503) 413-4134

3501 Mills Ave
Austin, TX 78731
Phone (512) 324-1017

3500 Gaston Ave
Dallas, TX 75246

5201 Harry Hines Blvd
Dallas, TX 75235
Phone (214) 590-1396

1200 E Brin St
Terrell, TX 75160
Phone (972) 524-6452

5323 Harry Hines Blvd
Ut Southwest Medical Center, TX 75390

2211 NE 139th St
Vancouver, WA 98686
Phone (360) 397-1985

1629 E Division St
River Falls, WI 54022
Phone (715) 307-6000

Organizations & group practices 19

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.

View all 19

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1303948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556236800000",
    "number": "1699066373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "807 WEST AVE",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787012207",
            "telephone_number": "888-285-2269",
            "fax_number": "512-838-4264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "474 N YELLOW SPRINGS STREET",
            "city": "SPRINGFIELD",
            "state": "OH",
            "postal_code": "455042938",
            "telephone_number": "937-399-9500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6051 U S Highway 49",
            "address_purpose": "LOCATION",
            "city": "Hattiesburg",
            "state": "MS",
            "postal_code": "394017201",
            "country_code": "US",
            "telephone_number": "601-288-7000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1629 E Division St",
            "address_purpose": "LOCATION",
            "city": "River Falls",
            "state": "WI",
            "postal_code": "540221571",
            "country_code": "US",
            "telephone_number": "715-307-6000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1015 NW 22nd Ave",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972103025",
            "country_code": "US",
            "telephone_number": "503-413-7711",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2211 NE 139th St",
            "address_purpose": "LOCATION",
            "city": "Vancouver",
            "state": "WA",
            "postal_code": "986862742",
            "country_code": "US",
            "telephone_number": "360-487-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3500 Gaston Ave",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752462088",
            "country_code": "US",
            "telephone_number": "214-820-0111",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "700 S Park St",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "WI",
            "postal_code": "537151830",
            "country_code": "US",
            "telephone_number": "608-251-6100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2505 Mission Dr",
            "address_purpose": "LOCATION",
            "city": "Jefferson City",
            "state": "MO",
            "postal_code": "651099508",
            "country_code": "US",
            "telephone_number": "573-681-3000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4050 Coon Rapids Blvd NW",
            "address_purpose": "LOCATION",
            "city": "Coon Rapids",
            "state": "MN",
            "postal_code": "554332522",
            "country_code": "US",
            "telephone_number": "763-236-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IVANOVA",
        "first_name": "KATERYNA",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-04-28",
        "last_updated": "2019-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MN",
            "license": "63625",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "Q3892",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WI",
            "license": "19-321",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WA",
            "license": "OP60851495",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OR",
            "license": "DO187158",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MO",
            "license": "20190133398",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MS",
            "license": "26323",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OH",
            "license": "34.011156",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, OH

Sources for this page

Verify at the official NPI Registry.