Active NPI
Ihor J Fedorak, M.D.
- Surgery Physician
- Colorado Springs, CO
National Provider Identifier
1861467094
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 33434
- Practice address
- 2222 N Nevada Ave
Suite 5017
Colorado Springs, CO 80907-6831 - Phone
- (719) 635-2501
- Fax
- (719) 632-1062
- NPI assigned
- Feb 21, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 33434 | CO | Primary |
Addresses
Primary practice location
2222 N Nevada Ave
Suite 5017
Colorado Springs, CO 80907-6831
Mailing address
2222 N Nevada Ave
Suite 5017
Colorado Springs, CO 80907-6831
Phone (719) 635-2501
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 020048149 | Other | RAILROAD MEDICARE | |
| 01334341 | Medicaid | CO | |
| 5199598 | Other | AETNA PIN | |
| IH35397 | Other | CO | COLORADO BLUE SHIELD |
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 |
|---|---|---|---|
| 33434 | CO | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140480000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594166400000",
"number": "1861467094",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2222 N NEVADA AVE",
"address_2": "SUITE 5017",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809076831",
"telephone_number": "719-635-2501",
"fax_number": "719-632-1062"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2222 N NEVADA AVE",
"address_2": "SUITE 5017",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809076831",
"telephone_number": "719-635-2501",
"fax_number": "719-632-1062"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FEDORAK",
"first_name": "IHOR",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-21",
"last_updated": "2020-07-08",
"certification_date": "2020-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "CO",
"license": "33434",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "020048149",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01334341",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA PIN",
"identifier": "5199598",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COLORADO BLUE SHIELD",
"identifier": "IH35397",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Colorado Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.