Robert Pendrak, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME85025 Issued in FL

Practice address

6500 Crill Ave
Palatka, FL 32177-9230

Phone

(386) 326-0575

Fax

(386) 326-0571

NPI assigned

Apr 21, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in FL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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 and National Provider Directory roles.

• FM Medical Urgent Care, Inc.

  • Urgent Care Clinic/Center
  • St Augustine, FL
  • NPI 1053790246
  NPD
• Pecos Valley of New Mexico, LLC

  • General Practice Physician
  • Carlsbad, NM
  • NPI 1972569820
  NPD (past)

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

{
    "created_epoch": "1145577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572134400000",
    "number": "1477519361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6500 CRILL AVE",
            "city": "PALATKA",
            "state": "FL",
            "postal_code": "321779230",
            "telephone_number": "386-326-0575",
            "fax_number": "386-326-0571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6500 CRILL AVE",
            "city": "PALATKA",
            "state": "FL",
            "postal_code": "321779230",
            "telephone_number": "386-326-0575",
            "fax_number": "386-326-0571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENDRAK",
        "first_name": "ROBERT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-21",
        "last_updated": "2019-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NM",
            "license": "MD2005-0209",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME85025",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "NVEXF",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00221334",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "00NM009V36",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "26351232",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Palatka SNF Operations LLC
• Kiesha Lashawn Parkinson, RN
• Patrick J Harris D O P a
• Larry William Pederson, R.PH., C.PH.
• Mark Peluso, LCSW
• Peopleone Health Florida, LLC
• Richard A. Perallon, DMD
• Maria Del Carmen Perez-Garcia, MD
• Teresa A Perez, LMHC CAP
• PF Dent, PA

• Family Medicine Physician in Palatka, FL
• Providers in Palatka, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2019; 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.

Verify at the official NPI Registry.