Individual provider Active NPI

Ivan Bandovic, DO

  • Orthopaedic Surgery Physician
  • Albany, NY
National Provider Identifier
1912526773
Registry record updated Jul 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
337402 Issued in NY
Practice address
121 Everett Rd
Albany, NY 12205-1474
Phone
(518) 489-2663
Fax
(518) 689-3910
NPI assigned
Apr 13, 2020
Last updated
Jul 21, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Orthopaedic Surgery Physician 207X00000X 337402 NY Primary

Addresses

Primary practice location

121 Everett Rd
Albany, NY 12205-1474

Mailing address

121 Everett Rd
Albany, NY 12205-1474
Phone (518) 489-2663

Other practice location 1

22101 Moross Rd Ste 214
Detroit, MI 48236-2148
Phone (313) 343-4000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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 1

Enrollment IDStateProvider typePAC IDDetails
I20200706000698 MI Order and Referring Only - Orthopedic SurgeryPractitioner - Orthopedic Surgery 0749603066

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
337402NYMDLicensed Practical Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopedicsny, LLP CurrentSince Sep 1, 2026 Accepting new patients
Orthopedicsny, LLP Orthopaedic Surgery PastSince Sep 1, 2026 Accepting new patients

Locations

121 Everett Rd
Colonie, NY 12205

1768 Route 9
Halfmoon, NY 12065

Organizations & group practices 2

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": "1586736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784592000000",
    "number": "1912526773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 EVERETT RD",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122051474",
            "telephone_number": "518-489-2663",
            "fax_number": "518-689-3910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 EVERETT RD",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122051474",
            "telephone_number": "518-489-2663",
            "fax_number": "518-689-3910"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "22101 Moross Rd Ste 214",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482362148",
            "country_code": "US",
            "telephone_number": "313-343-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BANDOVIC",
        "first_name": "IVAN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-13",
        "last_updated": "2026-07-21",
        "certification_date": "2026-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NY",
            "license": "337402",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, NY

Sources for this page

Verify at the official NPI Registry.