NPIMap

Individual provider Active NPI

Paul S Dereska, D.O.

  • Anesthesiology Physician
  • Plano, TX
National Provider Identifier
1063502755
Registry record updated Sep 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
N5013 Issued in TX
Practice address
3308 Preston Rd
Ste. 350-283
Plano, TX 75093-7453
Phone
(214) 471-5975
NPI assigned
Oct 13, 2006
Last updated
Sep 10, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X N5013 TX Primary

Addresses

Primary practice location

3308 Preston Rd
Ste. 350-283
Plano, TX 75093-7453

Mailing address

45 Bass Pond Dr
Frisco, TX 75034-1937
Phone (469) 600-5681

Other identifiers 4

IdentifierTypeStateIssuer
010242193MedicaidVA
305164102MedicaidTX
8DL180OtherTXBLUE CROSS BLUE SHIELD
302164101MedicaidTX

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)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Carilion Emergency Services, Inc. Past Accepting new patients
Carilion Emergency Services, Inc. PastSince Dec 17, 2023 Accepting new patients
S&R Meridian Managment,LLC Anesthesiology PastSince Nov 1, 2020 Accepting new patients
Team Physicians of Arizona PC Emergency Medicine Past Accepting new patients

Organizations & group practices 4

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": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568073600000",
    "number": "1063502755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 BASS POND DR",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750341937",
            "telephone_number": "469-600-5681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3308 PRESTON RD",
            "address_2": "STE. 350-283",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750937453",
            "telephone_number": "214-471-5975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERESKA",
        "first_name": "PAUL",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-13",
        "last_updated": "2019-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "TX",
            "license": "N5013",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010242193",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "305164102",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "8DL180",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "302164101",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plano, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.