NPIMap

Individual provider Active NPI

George Sivak, DO

  • Emergency Medicine Physician
  • Youngstown, OH
National Provider Identifier
1902843899
Registry record updated Nov 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
34004606S Issued in OH
Practice address
1305 Boardman Poland Rd
Youngstown, OH 44514-1935
Phone
(330) 629-2300
Fax
(330) 629-2371
NPI assigned
Jun 1, 2006
Last updated
Nov 29, 2012By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 29, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 34004606S OH Primary

Addresses

Primary practice location

1305 Boardman Poland Rd
Youngstown, OH 44514-1935

Mailing address

2601 Mission Point Blvd
Suite 100
Beavercreek, OH 45431-6600
Phone (937) 912-4441

Other identifiers 3

IdentifierTypeStateIssuer
0714794MedicaidOH
942460636209OtherOHCARESOURCE
P00220368OtherOHMEDICARE RR-GA

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 Osteopathy

State licenses

LicenseStateTypeSpecialty
34004606SOHMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Youngstown Ohio Outpatient Services Company LLC Past Accepting new patients
Lakewood Hospital Association Emergency Medicine Past Accepting new patients
Trinity Hospital Holding Company Past Accepting new patients
Lakewood Hospital Association Past Accepting new patients
Dwic of Tampa Bay, Inc Past Accepting new patients

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354147200000",
    "number": "1902843899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2601 MISSION POINT BLVD",
            "address_2": "SUITE 100",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454316600",
            "telephone_number": "937-912-4441",
            "fax_number": "937-429-4236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 BOARDMAN POLAND RD",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445141935",
            "telephone_number": "330-629-2300",
            "fax_number": "330-629-2371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIVAK",
        "first_name": "GEORGE",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-01",
        "last_updated": "2012-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OH",
            "license": "34004606S",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0714794",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARESOURCE",
            "identifier": "942460636209",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR-GA",
            "identifier": "P00220368",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Youngstown, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.