Active NPI
Susan I Ivancevich, M.D.
- Diagnostic Radiology Physician
- Indianapolis, IN
National Provider Identifier
1740223809
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 01043743A
- Practice address
- 7340 Shadeland Sta
Suite 200
Indianapolis, IN 46256-3979 - Phone
- (317) 806-8260
- Fax
- (317) 806-8296
- NPI assigned
- Jun 14, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 01043743A | IN | Primary |
Addresses
Primary practice location
7340 Shadeland Sta
Suite 200
Indianapolis, IN 46256-3979
Mailing address
7340 Shadeland Sta
Suite 200
Indianapolis, IN 46256-3979
Phone (317) 806-8260
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200047420 | Medicaid | IN | |
| 000000208329 | Other | IN | ANTHEM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01043743A | IN | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Health Network, Inc | Past | Accepting new patients | |
| Indiana University Radiology Associates, Inc. | Diagnostic Radiology | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Community/Retail Pharmacy
- Indianapolis, IN
- NPI 1669951471
-
- Diagnostic Radiology Physician
- Indianapolis, IN
- NPI 1336192665
Diagnostic Radiology
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1415923200000",
"number": "1740223809",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7340 SHADELAND STA",
"address_2": "SUITE 200",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462563979",
"telephone_number": "317-806-8260",
"fax_number": "317-806-8296"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7340 SHADELAND STA",
"address_2": "SUITE 200",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462563979",
"telephone_number": "317-806-8260",
"fax_number": "317-806-8296"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IVANCEVICH",
"first_name": "SUSAN",
"middle_name": "I",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-14",
"last_updated": "2014-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "IN",
"license": "01043743A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200047420",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000208329",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.