Xenie Ivancova, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

ME32438 Issued in FL

Practice address

400 W Airport Blvd
Sanford, FL 32773-5489

Phone

(407) 665-3341

Fax

(407) 665-3213

NPI assigned

Feb 20, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1140393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354665600000",
    "number": "1780659185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 W AIRPORT BLVD",
            "city": "SANFORD",
            "state": "FL",
            "postal_code": "327735489",
            "telephone_number": "407-665-3212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 W AIRPORT BLVD",
            "city": "SANFORD",
            "state": "FL",
            "postal_code": "327735489",
            "telephone_number": "407-665-3341",
            "fax_number": "407-665-3213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVANCOVA",
        "first_name": "XENIE",
        "name_prefix": "Mrs.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-20",
        "last_updated": "2012-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME32438",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "039272300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Innovative Healthcare Solutions of Florida LLC
• Integrated Community Oncology Network LLC
• Integrated Regional Laboratories Pathology Services, LLC
• Integrated Regional Laboratories Pathology Services, LLC
• Integrative Physical Medicine of Sanford, LLC
• J D Mobile Health Services Inc
• Bernadete Jackson
• Deja Jackson
• Kimcheree Jackson
• Taiwan Jackson, LPN

• Internal Medicine Physician in Sanford, FL
• Providers in Sanford, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2012; 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.