Ivan Ivanov, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

CP017621T Issued in CO

Practice address

2611 Jones Ave
Pueblo, CO 81004-2650

Phone

(719) 564-1735

NPI assigned

Feb 10, 2020

Sex

Male

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 NV

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Chynoweth Hill and Leavitt LLCGroup PAC ID 7012980550, 41 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Chynoweth Hill and Leavitt LLC

  • Multi-Specialty Clinic/Center
  • Las Vegas, NV
  • NPI 1164415279

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• Chynoweth Hill and Leavitt LLC

  • Multi-Specialty Clinic/Center
  • Las Vegas, NV
  • NPI 1780303727
  NPD

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

{
    "created_epoch": "1581292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674086400000",
    "number": "1942832803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "655 S WILLOW ST STE 128",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031035723",
            "telephone_number": "800-995-2673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2611 JONES AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810042650",
            "telephone_number": "719-564-1735"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "914 Justison St",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "DE",
            "postal_code": "198015150",
            "country_code": "US",
            "telephone_number": "302-351-0302",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2607 Wyoming Blvd NE",
            "address_purpose": "LOCATION",
            "city": "Albuquerque",
            "state": "NM",
            "postal_code": "871121029",
            "country_code": "US",
            "telephone_number": "505-296-9521",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IVANOV",
        "first_name": "IVAN",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-02-10",
        "last_updated": "2023-01-19",
        "certification_date": "2023-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "DE",
            "license": "J1-0004181",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CO",
            "license": "CP017621T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peggy Jo Irby, RDH
• Karen Marie Irick, LCSW, LAC
• Aprie Irwin, LPC
• Ufaq Ishtiaq
• Pamela Isley, NP
• Jennifer L. Iverson
• Pamela Jean Ivey, RN
• J Kevin Johnson MD PC
• J. Valentine Cichon, MD PC
• Ryan D Jaarsma, PSY.D.

• Physical Therapist in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Physical Therapist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.