Michael Eric Ivory, DO

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

5101007170 Issued in MI

Practice address

516 E. Nizhoni Blvd.
Gallup, NM 87301-1337

Phone

(505) 722-1000

Fax

(505) 726-8740

NPI assigned

Apr 26, 2007

Last updated

Sep 27, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

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.

• Clinton Indian Health Center

  • Federal Public Health Clinic/Center
  • Clinton, OK
  • NPI 1205923448
  NPD (past)
• Genesys Regional Medical Center

  • Diagnostic Radiology Physician
  • Lapeer, MI
  • NPI 1134152226
  NPD (past)

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

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348704000000",
    "number": "1952521874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4070 N CHIPMAN ST",
            "city": "OWOSSO",
            "state": "MI",
            "postal_code": "488679444",
            "telephone_number": "989-723-5236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 E. NIZHONI BLVD.",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873011337",
            "telephone_number": "505-722-1000",
            "fax_number": "505-726-8740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVORY",
        "first_name": "MICHAEL",
        "middle_name": "ERIC",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-26",
        "last_updated": "2012-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MI",
            "license": "5101007170",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4709700",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30010400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jonathan Vilasier Iralu, M.D.
• Mary Eve Iralu
• Ironclad Home Health Care LLC
• Ironclad Hospice Care, LLC
• Nancy C Ison, RN
• J&B Medical Supply Co Inc
• Natalie Jache, RN
• Danny Jackson, BSN
• Michelle Lee Jackson, RN
• Neil Christopher Jackson, M.D.

• General Practice Physician in Gallup, NM
• Providers in Gallup, NM by specialty
• General Practice Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 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.