NPIMap

Individual provider Active NPI

Ian Levi Stines, M.D.

  • Vascular Surgery Physician
  • Bowling Green, KY
National Provider Identifier
1952711665
Registry record updated Aug 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
TP992 Issued in KY
Practice address
825 2ND Ave Ste B1
Bowling Green, KY 42101-1790
Phone
(270) 796-3330
Fax
(270) 796-3338
NPI assigned
May 2, 2014
Last updated
Aug 19, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 125-065649 IL
Surgery Physician 208600000X 036.153047 IL
Vascular Surgery Physician 2086S0129X TP992 KY Primary

Addresses

Primary practice location

825 2ND Ave Ste B1
Bowling Green, KY 42101-1790

Mailing address

PO Box 2697
Bowling Green, KY 42102-7697
Phone (270) 745-1100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220928002209 KY Practitioner - Vascular Surgery 1951690874 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
University of Texas Medical School at Houston, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

825 2ND Ave
Suite B2
Bowling Green, KY 42101-1790
Phone (270) 796-3535

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal14
Leg revascularization (restoring blood flow)16
Removal of tissue20

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.153047ILMDSurgery Physician
125-065649ILMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Commonwealth Health Corporation, Inc CurrentSince Sep 1, 2022 Accepting new patients
Commonwealth Health Corporation, Inc. CurrentSince Sep 1, 2022 Accepting new patients
Commonwealth Health Corporation, Inc Current Accepting new patients
Commonwealth Health Corporation Past Accepting new patients

Locations

723 Burkesville Rd
Albany, KY 42602
Phone (606) 387-6421

250 Park St
Bowling Green, KY 42101
Phone (270) 745-1000

350 Park St
Ste 203
Bowling Green, KY 42101
Phone (270) 781-0075

825 2nd Ave
Ste B1
Bowling Green, KY 42101
Phone (270) 843-8600

825 2nd Ave
Ste B2
Bowling Green, KY 42101
Phone (270) 780-2660

Organizations & group practices 4

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.

Hospital & facility affiliations 7

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": "1398988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660867200000",
    "number": "1952711665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2697",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421027697",
            "telephone_number": "270-745-1100",
            "fax_number": "270-745-1156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 2ND AVE STE B1",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421011790",
            "telephone_number": "270-796-3330",
            "fax_number": "270-796-3338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STINES",
        "first_name": "IAN",
        "middle_name": "LEVI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-02",
        "last_updated": "2022-08-19",
        "certification_date": "2022-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "125-065649",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036.153047",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "KY",
            "license": "TP992",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowling Green, KY

Sources for this page

Verify at the official NPI Registry.