Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

SAMUIL IVANOVSKY
NPI 1417698317
General Practice in Little Rock, AR

Q: What is Samuil Ivanovsky's NPI number?

The NPI number for Samuil Ivanovsky is 1417698317. It was assigned to this individual provider in the NPPES registry on April 5, 2022.

Q: What is Samuil Ivanovsky's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Q: When was this NPI record last updated?

The NPPES record for Samuil Ivanovsky was last updated on August 7, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 25 days 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 05, 2022PECOS Enrolled

4301 W MARKHAM ST # 634, LITTLE ROCK, AR 72205(501) 686-7592 Get Directions Write a Review

NPPES record last updated: August 7, 2026. Verified against the NPPES registry weekly; last sync: August 30, 2026.

Record update history: Aug 7, 2026, Apr 5, 2022 (2 updates tracked since 2022).

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About Samuil Ivanovsky NPPES

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

SAMUIL IVANOVSKY (NPI 1417698317) is an individual general practice provider in Little Rock, Arkansas, licensed in Arkansas (E-19099) and active in the NPI registry since April 2022. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1417698317

Entity TypeIndividualMale

Primary Taxonomy208D00000X

Provider Legal NameSAMUIL IVANOVSKY

Location Address4301 W MARKHAM ST # 634Little Rock, AR 72205-7199

Mailing Address4301 W Markham St # 634Little Rock, AR 72205-7199 · (501) 686-7592

Phone(501) 686-7592

Sole ProprietorYes

Enumeration DateApril 5, 2022

Last NPPES UpdateAugust 7, 20262 updates tracked since enumeration

NPPES CertifiedAugust 7, 2026

✔ NPI 1417698317 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians

Taxonomy Code208D00000X

License✔ Licensed in AR · E-19099

Definition

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

4301 W MARKHAM ST # 634, Little Rock, AR 72205

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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 (PECOS)

Samuil Ivanovsky is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

Other Providers at the Same Location NPPES 20

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

MU'NES ALBADAINEH MD

Student in an Organized Health Care Education/Training Program