Ethan Pavlovsky, DO

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

W4177 Issued in TX

Practice address

3901 W 15TH St
Plano, TX 75075-7738

Phone

(972) 396-4075

NPI assigned

Mar 20, 2022

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

Medicare fee-for-service enrollment

Enrolled in TX

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 Practice

Education

Other, 2024

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• CSH Corp.

  • General Practice Physician
  • Dallas, TX
  • NPI 1386518355
  Medicare reassignment

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

{
    "created_epoch": "1647734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772928000000",
    "number": "1407505233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 W 15TH ST",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750757738",
            "telephone_number": "972-396-4075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 W 15TH ST",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750757738",
            "telephone_number": "972-396-4075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAVLOVSKY",
        "first_name": "ETHAN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-20",
        "last_updated": "2026-03-08",
        "certification_date": "2026-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "TX",
            "license": "W4177",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marisol B Pauling, CCC/SLP
• Lisa Paulsen, LCDC
• Lara Pavageau, MD
• Pavan Pamadurthi M.D., P.a.
• Anna Pavlisova, LMFT-A
• Sarah N Payberah, M.D.
• Susan R Payberah, M.D.
• Emily Rae Payma, LCSW
• Annette Payne, RD
• Janea Marie Payne, RN

• General Practice Physician in Plano, TX
• Providers in Plano, TX by specialty
• General Practice Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2026; 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.