Michelle Lynae Iverson, M.D.

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

U8537 Issued in TX

Practice address

4085 De Zavala Rd Ste 200
Shavano Park, TX 78249-2084

Phone

(210) 558-6288

Fax

(210) 558-6289

NPI assigned

Apr 14, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in SD, OH2 enrollments

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.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Avera St. Luke'S

  • Internal Medicine Physician
  • Aberdeen, SD
  • NPI 1215100813
  Medicare reassignment NPD
• Somc Medical Care Foundation, Inc.

  • Family Medicine Physician
  • Portsmouth, OH
  • NPI 1457467227
  Medicare reassignment NPD
• Avera St Lukes

  • General Acute Care Hospital
  • Aberdeen, SD
  • NPI 1457309270
  NPD
• Avera St. Lukes

  • Nephrology Physician
  • Aberdeen, SD
  • NPI 1477594430
  NPD
• Somc Medical Care Foundation, Inc.

  • Diagnostic Radiology Physician
  • Portsmouth, OH
  • NPI 1366686230
  NPD
• Cumberland Lung Specialists

  • Pulmonary Disease Physician
  • Hermitage, TN
  • NPI 1972799807
  NPD (past)
• Yosemite Pathology Medical Group, in

  • Clinical Medical Laboratory
  • Tracy, CA
  • NPI 1114192176
  NPD (past)

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

{
    "created_epoch": "1239667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717027200000",
    "number": "1912140302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 681149",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782681149",
            "telephone_number": "210-558-6288",
            "fax_number": "210-558-6289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4085 DE ZAVALA RD STE 200",
            "city": "SHAVANO PARK",
            "state": "TX",
            "postal_code": "782492084",
            "telephone_number": "210-558-6288",
            "fax_number": "210-558-6289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVERSON",
        "first_name": "MICHELLE",
        "middle_name": "LYNAE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-14",
        "last_updated": "2024-05-30",
        "certification_date": "2024-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "TN",
            "license": "53547",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "CA",
            "license": "A115609",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "TX",
            "license": "U8537",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica A Hetherington, MD
• Teresa E Hirst, CPNP
• Bianca Horton, MS SLP -INTERN
• Priscilla Hover, PA-C
• Kathleen Howard, CNIM
• Jaydeep S. Shah, M.D. PLLC
• JM Dental Services, PLLC
• Kaiser Family Medical Management
• David R Kaiser, D.C.
• Lindsay Jo Kane

• Anatomic Pathology & Clinical Pathology Physician in Shavano Park, TX
• Providers in Shavano Park, TX by specialty
• Anatomic Pathology & Clinical Pathology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2024; 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.