Ivan Nicolas Vial, MD

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

MD180009 Issued in OR

Practice address

2450 NE Mary Rose PL Ste 201
Bend, OR 97701-7133

Phone

(541) 317-0808

NPI assigned

Jul 3, 2011

Sex

Male

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: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 30, 2022 through Oct 30, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1309651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560211200000",
    "number": "1811284433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 NE MARY ROSE PL",
            "address_2": "STE 201",
            "city": "BEND",
            "state": "OR",
            "postal_code": "97701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 NE MARY ROSE PL STE 201",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977017133",
            "telephone_number": "541-317-0808"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3550 Terrace St",
            "address_2": "683 Scaife Hall",
            "address_purpose": "LOCATION",
            "city": "Pittsburgh",
            "state": "PA",
            "postal_code": "152132500",
            "country_code": "US",
            "telephone_number": "412-383-8082",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VIAL",
        "first_name": "IVAN",
        "middle_name": "NICOLAS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-03",
        "last_updated": "2019-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "OR",
            "license": "MD180009",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500719243",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Peri Rose Vernon, CNM
• Loni Verzuh, PMHNP
• Bryant Vette
• Anna Veverka
• Teresa Dawn Veverka, MSW
• Alicia Viani, LCSW
• Robin Kay Vickery, LCSW
• Victory Chiropractic
• Viewpoint Therapy
• Darion Linda Vigueria

• Plastic Surgery Physician in Bend, OR
• Providers in Bend, OR by specialty
• Plastic Surgery Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.