Active NPI
Jenny Peloquen, D.O.
- Psychiatry Physician
- Austin, TX
National Provider Identifier
1487666400
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- L1164
- Practice address
- 1101 S Capital of Texas Hwy
BLDG a, Suite 102
Austin, TX 78746-6445 - Phone
- (512) 740-0962
- NPI assigned
- Aug 12, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 | L1164 | TX | Primary |
Addresses
Primary practice location
1101 S Capital of Texas Hwy
BLDG a, Suite 102
Austin, TX 78746-6445
Mailing address
1101 S Capital of Texas Hwy
BLDG a, Suite 102
Austin, TX 78746-6445
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Previously, effective Aug 1, 2016 through Aug 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L1164 | TX | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155340800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1487666400",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1101 S CAPITAL OF TEXAS HWY",
"address_2": "BLDG A, SUITE 102",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787466445"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1101 S CAPITAL OF TEXAS HWY",
"address_2": "BLDG A, SUITE 102",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787466445",
"telephone_number": "512-740-0962"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PELOQUEN",
"first_name": "JENNY",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "TX",
"license": "L1164",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.