Carl Matthew Pesta, D.O.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

5101013083 Issued in MI

Practice address

1030 Harrington St
302A
Mount Clemens, MI 48043-2967

Phone

(586) 759-2005

Fax

(586) 759-2636

NPI assigned

Apr 21, 2006

Last updated

May 26, 2015By the provider in NPPES

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

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

Specialty

General Surgery

Education

Michigan State University College of Osteopathic Medicine, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Regional Trauma Care PCGroup PAC ID 3173691771, 10 clinicians

McLaren MacombGroup PAC ID 8921912791, 131 clinicians

Surgical Consultants PLLCGroup PAC ID 6800803917, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• McLaren Macomb Hospital, Mount Clemens, MI, CCN 230227
• McLaren Port Huron Hospital, Port Huron, MI, CCN 230216

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Regional Trauma Care PC

  • Surgery Physician
  • Mount Clemens, MI
  • NPI 1851554497
  Medicare reassignment Care Compare group NPD
• Surgical Consultants PLLC

  • Surgery Physician
  • Mount Clemens, MI
  • NPI 1891708814
  Medicare reassignment Care Compare group NPD
• McLaren Macomb

  • Internal Medicine Physician
  • Mount Clemens, MI
  • NPI 1396014601
  Medicare reassignment Care Compare group
• McLaren Port Huron

  dba Port Huron Hospital Physician GRP

  • Psychiatry Physician
  • Port Huron, MI
  • NPI 1386888170
  Medicare reassignment NPD
• McLaren Port Huron

  • Family Medicine Physician
  • Port Huron, MI
  • NPI 1619355930
  NPD
• ENT Surgical Assoc PC

  • Otolaryngology/Facial Plastic Surgery Physician
  • Madison Heights, MI
  • NPI 1225073687
  NPD (past)
• McLaren Macomb

  • General Acute Care Hospital
  • Mount Clemens, MI
  • NPI 1316938327
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• McLaren Macomb

  • Psychiatric Hospital Unit
  • Shelby Township, MI
  • NPI 1184206385
  Care Compare affiliation
• McLaren Macomb

  • General Acute Care Hospital
  • Mount Clemens, MI
  • NPI 1316938327
  Care Compare affiliation
• McLaren Port Huron

  • General Acute Care Hospital
  • Port Huron, MI
  • NPI 1982685384
  Care Compare affiliation

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

{
    "created_epoch": "1145577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1432598400000",
    "number": "1114983913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1030 HARRINGTON ST",
            "address_2": "SUITE 302A",
            "city": "MOUNT CLEMENS",
            "state": "MI",
            "postal_code": "480432967",
            "telephone_number": "586-759-2005",
            "fax_number": "586-759-2636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 HARRINGTON ST",
            "address_2": "302A",
            "city": "MOUNT CLEMENS",
            "state": "MI",
            "postal_code": "480432967",
            "telephone_number": "586-759-2005",
            "fax_number": "586-759-2636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PESTA",
        "first_name": "CARL",
        "middle_name": "MATTHEW",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-21",
        "last_updated": "2015-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "5101013083",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PIN",
            "identifier": "0255003665",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114446930",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristen Peers, LPC
• Perceptions Counseling Services, P.C.
• Marianne Perraut, PA-C
• Andrea Perrin, DO
• Alivia Perry
• Monica Joanna Petela
• Rebecca Emily Peters, DO
• Brandon Phillips
• Timothy P Pierron, DO
• Heather Piper, PT

• Surgery Physician in Mount Clemens, MI
• Providers in Mount Clemens, MI by specialty
• Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2015; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.