NPI |
1437935723 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Entity Type Code |
2 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Employer Identification Number EIN |
|
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Provider Organization Name Legal Business Name |
IVIM, PLLC |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Provider First Line Business Practice Location Address |
4200 REGENT ST STE 200 |
The last name of the provider. If the provider is an individual, this is the legal name. |
Provider Business Practice Location Address City Name |
COLUMBUS |
The first name of the provider, if the provider
is an individual. |
Provider Business Practice Location Address State Name |
OH |
The middle name of the provider, if the provider
is an individual. |
Provider Business Practice Location Address Postal Code |
432196229 |
The abbreviations for professional degrees or credentials used or held by the provider,
if the provider is an individual. Examples
are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations
will not be verified by NPS. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address Telephone Number |
8775812210 |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address Fax Number |
6149688840 |
The State code in the location of the provider
being identified. |
Provider Enumeration Date |
9/4/2023 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Last Update Date |
9/4/2023 |
The country code in the location address of the provider being identified. |
Authorized Official Last Name |
KANTOR |
The telephone number associated with the location address of the provider being identified. |
Authorized Official First Name |
TAYLOR |
The fax number associated with the location
address of the provider being identified. |
Authorized Official Title or Position |
MEDICAL DIRECTOR |
The title or position of the authorized official. |
Authorized Official Telephone Number |
6149402204 |
The 10-position telephone number of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
261QP2300X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Is Organization Subpart |
N |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Authorized Official Name Prefix Text |
DR. |
|
Authorized Official Credential Text |
MD |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
NPI Certification Date |
9/4/2023 |
|