Individual provider Active NPI

John Anton Pesavento, M.D

  • Psychiatry Physician
  • Omaha, NE
National Provider Identifier
1073954061
Registry record updated Nov 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
29489 Issued in NE
Practice address
1000 N 90TH St Ste 200
Omaha, NE 68114-2766
Phone
(402) 955-3900
Fax
(402) 955-3920
NPI assigned
Jul 8, 2013
Last updated
Nov 21, 2018By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 21, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 29489 NE Primary

Addresses

Primary practice location

1000 N 90TH St Ste 200
Omaha, NE 68114-2766

Mailing address

1000 N 90TH St Ste 200
Omaha, NE 68114-2766
Phone (402) 250-1665

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE
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

Enrollment IDStateProvider typePAC IDDetails
I20140325001839 NE Order and Referring Only - PsychiatryPractitioner - Psychiatry 1759512395

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
29489NEMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Children's Specialty Physician Billing - Behavioral Health Psychiatry Past 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": "1373241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542758400000",
    "number": "1073954061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 N 90TH ST STE 200",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681142766",
            "telephone_number": "402-250-1665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 N 90TH ST STE 200",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681142766",
            "telephone_number": "402-955-3900",
            "fax_number": "402-955-3920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PESAVENTO",
        "first_name": "JOHN",
        "middle_name": "ANTON",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-07-08",
        "last_updated": "2018-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NE",
            "license": "29489",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.