IVAN GLOTOV PA
NPI 1255126124
Physician Assistant in Stockbridge, GA

Q: What is Ivan Glotov's NPI number?

The NPI number for Ivan Glotov is 1255126124. It was assigned to this individual provider in the NPPES registry on April 11, 2025.

Q: What is Ivan Glotov's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Q: When was this NPI record last updated?

The NPPES record for Ivan Glotov was last updated on April 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since April 11, 2025PECOS EnrolledAccepts Medicare Assignment

1240 EAGLES LANDING PKWY STE 300, STOCKBRIDGE, GA 30281(770) 506-4350(770) 506-9860 Get Directions Write a Review

NPPES record last updated: April 11, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Ivan Glotov Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

IVAN GLOTOV PA (NPI 1255126124) is an individual physician assistant in Stockbridge, Georgia and active in the NPI registry since April 2025. He is enrolled in Medicare PECOS, is affiliated with Piedmont Henry Hospital, and is a graduate of Mercer University School Of Medicine (2025).

NPPES Registry Identity

NPI1255126124

Entity TypeIndividualMale

Primary Taxonomy363A00000X

Provider Legal NameIVAN GLOTOVCredential: PA

Location Address1240 EAGLES LANDING PKWY STE 300Stockbridge, GA 30281-5173

Mailing Address3100 Interstate North Cir Se Ste 500Atlanta, GA 30339-2296 · (678) 996-7230

Phone(770) 506-4350

Fax(770) 506-9860

Sole ProprietorNo

Medical School CMSMercer University School Of MedicineGraduated 2025

Enumeration DateApril 11, 2025

NPPES CertifiedApril 11, 2025

✔ NPI 1255126124 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

1240 EAGLES LANDING PKWY STE 300, Stockbridge, GA 30281

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Ivan Glotov Pa is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID749797413

PECOS Enrollment IDI20250728002573

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Piedmont Henry Hospital

Acute Care Hospitals · Stockbridge, GA

2/5 CMS rating

OwnershipGovernment - Hospital District or Authority

CMS Certification Number110191

Location1133 Eagle's Landing ParkwayStockbridge, GA 30281 · Henry County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 30281 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$88.06 typical visit price

range $56.84 – $172.43

Typical copayment $22.01 (range $14.21 – $43.10)

Most-billed visit code 99203

Established Patient

$70.85 typical visit price

range $18.22 – $140.40

Typical copayment $17.71 (range $4.55 – $35.10)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 13

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BRIANA STITH PA-C

Physician Assistant