Active NPI
Evan Pedersen, D.M.D.
- General Practice Dentistry
- Ocala, FL
National Provider Identifier
1043552516
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D20055
- Practice address
- 9401 SW Highway 200
Suite 101
Ocala, FL 34481-9612 - Phone
- (352) 873-2000
- NPI assigned
- Mar 22, 2013
- Last updated
- Jul 12, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D20055 | FL | Primary |
Addresses
Primary practice location
9401 SW Highway 200
Suite 101
Ocala, FL 34481-9612
Mailing address
4900 SW 46TH CT
Apt 902
Ocala, FL 34474-6264
Phone (815) 975-8758
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D20055 | FL | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Evan Pedersen DMD, PLLC | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1363910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1373587200000",
"number": "1043552516",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4900 SW 46TH CT",
"address_2": "APT 902",
"city": "OCALA",
"state": "FL",
"postal_code": "344746264",
"telephone_number": "815-975-8758"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9401 SW HIGHWAY 200",
"address_2": "SUITE 101",
"city": "OCALA",
"state": "FL",
"postal_code": "344819612",
"telephone_number": "352-873-2000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEDERSEN",
"first_name": "EVAN",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-03-22",
"last_updated": "2013-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "FL",
"license": "D20055",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ocala, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.