Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Ivan M Grynyshin, MD

Individual provider Anesthesiology Physician · NPI 1124000369

Ivan M Grynyshin, MD is an Anesthesiology in Pottsville, Pennsylvania. Graduated from University of Tennessee, Hsc, College of Medicine in 2004, 22 years ago. Practices with The Pottsville PA Endoscopy ASC LP, a 3-clinician group and accepts Medicare assignment. Licensed in Pennsylvania.

Years since qualifying
22
Trained at
University of Tennessee, Hsc, College of Medicine
Licensed in
PA
In the registry since
2005
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

420 S Jackson St
Pottsville, PA 17901-3625
Phone: (570) 346-7797
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Anesthesiology Physician (primary) Taxonomy 207L00000X · Licence MD423998 (PA)

Record details

NPI number1124000369
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedNovember 15, 2005
Last updated in NPPESApril 20, 2009
Mailing addressPo Box 390, Scranton, PA 18501-0390

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyANESTHESIOLOGY
Medical schoolUNIVERSITY OF TENNESSEE, HSC, COLLEGE OF MEDICINE
Graduated 2004 (22 years in practice)
Group practice The Pottsville Pa Endoscopy Asc Lp — 3 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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