Individual provider Active NPI

Ivan Daniel Sequera Sanchez, M.D.

  • Anesthesiology Physician
  • Boston, MA
National Provider Identifier
1922363142
Registry record updated Jan 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
260816 Issued in MA
Practice address
800 Washington St # 298
Zizkind, Building, 6TH Floor
Boston, MA 02111-1552
Phone
(617) 636-6044
Fax
(617) 636-8384
NPI assigned
Jul 13, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2016

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 11016499A IN
Anesthesiology Physician 207L00000X 260816 MA Primary

Addresses

Primary practice location

800 Washington St # 298
Zizkind, Building, 6TH Floor
Boston, MA 02111-1552

Mailing address

62 Boylston St
Apt 418
Boston, MA 02116-4799
Phone (312) 350-8469

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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
I20171012002981 AL Practitioner - Anesthesiology 0749427698 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anesthesia Consultants Medical Group PCGroup PAC ID 8628975935, 15 clinicians

Practice addresses (Care Compare)

1108 Ross Clark Cir
Dothan, AL 36301-3022
Phone (334) 793-8111

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Anesthesia Consultants Medical Group PC Anesthesiology CurrentSince Aug 1, 2017 Accepting new patients
Southern Alabama Surgery Center LLC Anesthesiology CurrentSince Jul 24, 2019 Accepting new patients

Locations

1108 Ross Clark Cir
Dothan, AL 36301
Phone (334) 712-3635

2800 Ross Clark Cir
Dothan, AL 36301
Phone (334) 793-3411

1118 Ross Clark Cir
Ste 700
Dothan, AL 36301
Phone (334) 793-5105

2800 Ross Clark Cir
Ste 3
Dothan, AL 36301
Phone (334) 793-3411

Interoperability endpoints

  • Direct secure messaging: isequerasanchez11919@southeasthealth.direct-ci.com

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 and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1342137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452816000000",
    "number": "1922363142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "62 BOYLSTON ST",
            "address_2": "APT 418",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021164799",
            "telephone_number": "312-350-8469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 WASHINGTON ST # 298",
            "address_2": "ZIZKIND, BUILDING, 6TH FLOOR",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021111552",
            "telephone_number": "617-636-6044",
            "fax_number": "617-636-8384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEQUERA SANCHEZ",
        "first_name": "IVAN",
        "middle_name": "DANIEL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-13",
        "last_updated": "2016-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IN",
            "license": "11016499A",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MA",
            "license": "260816",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.