Andrew Pellegrin, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

30354 Issued in NE

Practice address

221 3Rd St W BLDG 1040
Jbsa Randolph, TX 78150-4800

Phone

(210) 652-8544

NPI assigned

Jun 2, 2016

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1464825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782691200000",
    "number": "1013365832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 3RD ST W BLDG 1040",
            "city": "JBSA RANDOLPH",
            "state": "TX",
            "postal_code": "781504800",
            "telephone_number": "210-652-8544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 3RD ST W BLDG 1040",
            "city": "JBSA RANDOLPH",
            "state": "TX",
            "postal_code": "781504800",
            "telephone_number": "210-652-8544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELLEGRIN",
        "first_name": "ANDREW",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-02",
        "last_updated": "2026-06-29",
        "certification_date": "2026-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NE",
            "license": "30354",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Milton R Miranda Rosa, MD
• Juan D Moreno, P.A.
• Angela Nance, LCSW
• John Yoonsik Oh, MD
• Alexander Scott Patlovany, PHARMD
• Tere Penland, APRN, CPNP-PC
• Patrick Andrew Pohle, LCSW
• Judy Rattan, O.D.
• Jennifer Lynn Ravenscroft, D.O.
• Seth Ravid

• Family Medicine Physician in Jbsa Randolph, TX
• Providers in Jbsa Randolph, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.