Active NPI
Edward Pellicano
- Psychiatry Physician
- Savannah, GA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 037330
- Practice address
- 1915 Eisenhower Dr
Savannah, GA 31406-5027 - Phone
- (912) 356-2011
- Fax
- (912) 351-3538
- NPI assigned
- Apr 25, 2006
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 037330 | GA | Primary |
Addresses
Primary practice location
1915 Eisenhower Dr
Savannah, GA 31406-5027
Mailing address
3 Belton LN
Savannah, GA 31411-1632
Phone (912) 598-0501
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 037330 | Other | GA | LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Americanwork, LLC | Current | Accepting new patients | |
| Americanwork, LLC | Current | Accepting new patients | |
| Pineland Area Community Services Board | Past | Accepting new patients |
Locations
1727 Wrightsboro Rd
Ste B
Augusta, GA 30904
Phone (706) 736-8170
421 12th St
Columbus, GA 31901
Phone (706) 494-7776
836 E 65th St
Ste 42
Savannah, GA 31405
Phone (912) 354-5780
Organizations & group practices 3
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.
-
dba Pineland BHDD CSB
- Community/Behavioral Health Agency
- Statesboro, GA
- NPI 1588735252
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145923200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1206662400000",
"number": "1225094402",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3 BELTON LN",
"city": "SAVANNAH",
"state": "GA",
"postal_code": "314111632",
"telephone_number": "912-598-0501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1915 EISENHOWER DR",
"city": "SAVANNAH",
"state": "GA",
"postal_code": "314065027",
"telephone_number": "912-356-2011",
"fax_number": "912-351-3538"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PELLICANO",
"first_name": "EDWARD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-25",
"last_updated": "2008-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "GA",
"license": "037330",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "037330",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Savannah, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2008; 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.