IVAN VICENTE (NPI# 1710201553) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710201553 |
| Entity Type | Individual |
| Full Name | IVAN VICENTE |
| Credential | IDMT |
| Practice Address |
433 Black Elk Ct Ellsworth Afb SD 57706-1847 |
| Practice Telephone | 6055213502 |
| Mailing Telephone | 6055213502 |
| Enumeration Date | 2010-03-23 |
| Last Update Date | 2010-03-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1710I1003X |
Military Health Care Provider Specialization: Independent Duty Medical Technicians |
Other Service Providers |
| Street Address |
433 BLACK ELK CT |
| City | ELLSWORTH AFB |
| State | SD |
| Zip Code | 57706-1847 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801307202 | Patrick David Jones | Physician Assistant | 28th Mdg/sggp, 2900 Doolittle Dr., Ellsworth Afb, SD 57706 | 2017-10-12 |
| 1770736522 | Amy Marie Kubal | Dietitian, Registered | 2450 Risner Drive, Ellsworth Air Force Base Health and Wellness Center, Ellsworth Afb, SD 57706 | 2008-10-24 |
| 1629576491 | Mario Luis Recupido IIi | Military Health Care Provider | 2900 Doolittle Dr, Ellsworth Afb, SD 57706 | 2018-01-26 |
| 1104337450 | Michael J Vadovsky | Physician Assistant | 2900 Doolittle Dr, Ellsworth Afb, SD 57706 | 2017-10-13 |
| 1275057754 | Adrianne Rae Littles | Military Health Care Provider | 2900 Doolittle Drive, Ellsworth Afb, SD 57706 | 2017-07-27 |
| 1780045427 | Dustin Ross Mayne | Pediatrics | 2900 Doolittle Dr, Ellsworth Afb, SD 57706 | 2016-03-08 |
| 1588993315 | Denise D Carcamo | Nurse Practitioner | 2900 Doolittle Dr, Ellsworth Afb, SD 57706 | 2009-12-07 |
| 1235363789 | Gregory Thomas Trifilo | Family Medicine | 2900 Doolittle Dr, Ellsworth Afb, SD 57706 | 2009-05-13 |
| 1982880563 | Sarah Zimmerman | Social Worker | 2900 Doolittle Dr, Ellsworth Afb, SD 57706 | 2008-01-14 |
| 1467501874 | Tasha Dee Standing Soldier | Pharmacist | 2900 Doolittle Drive, 28th Medical Group, Ellsworth Afb, SD 57706 | 2007-01-09 |
| Find all providers in zip 57706 | ||||
| Taxonomy Code | 1710I1003X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Specialization | Independent Duty Medical Technicians |
| An Independent Duty Medical Technician (IDMT) is specially trained and educated to perform primary medical care, minor surgical services, and treatment of dental disorders for active duty military members in a variety of health care and non-health care settings worldwide under direct and indirect physician supervision. An IDMT may take medical histories, perform physical exams, order lab tests and x-rays, prescribe medications, and give immunizations. IDMTs work under the direct supervision of a physician preceptor when at home station and indirectly when assigned to a Mobile Aid Station, Mobile Medical Unit, remote site, or otherwise deployed specifically as an IDMT. An IDMT may be an experienced Aerospace Medical Service Technician who meets special task qualifications and is recommended for training by the Aerospace Medical Service Functional Manager at their Medical Treatment Facility. IDMTs maintain certification as Nationally Registered Emergency Medical Technicians and as Immunization Back-up Technicians. |
| Notes: Source: Air Force Surgeon General Office [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629576491 | Mario Luis Recupido IIi | Military Health Care Provider | 2900 Doolittle Dr, Ellsworth Afb, SD 57706 | 2018-01-26 |
| 1073039889 | Anthony Zunker | Military Health Care Provider | 2900 Doolittle Dr, Ellsworth Afb, SD 57706-4821 | 2017-08-15 |
| 1275057754 | Adrianne Rae Littles | Military Health Care Provider | 2900 Doolittle Drive, Ellsworth Afb, SD 57706 | 2017-07-27 |
| 1487012738 | Mitchell Harkley | Military Health Care Provider | 2900 Doolittle Dr, Ellsworth Afb, SD 57706-4821 | 2016-02-02 |
| 1104050624 | Diane Ramirez | Military Health Care Provider | 2900 Doolittle Dr, Ellsworth Afb, SD 57706-4821 | 2009-05-12 |
| 1326282138 | Tara Lynn Dommert-harrison | Military Health Care Provider | 2900 Doolittle Dr, Ellsworth Afb, SD 57706-4821 | 2009-04-23 |
| 1750524955 | Gina Ann Laux | Military Health Care Provider | 2900 Doolittle Dr, Ellsworth Afb, SD 57706-4821 | 2009-04-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306118799 | Ellie V Dierkhising | Military Health Care Provider | 4526 Candlewood Pl Apt 201, Rapid City, SD 57702-0196 | 2012-02-01 |
| City | ELLSWORTH AFB |
| Zip Code | 57706 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.