Active NPI
Alexandros John Pavlides
- Medical Physician Assistant
- St George, UT
National Provider Identifier
1497103485
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 11799232-1206
- Practice address
- 640 E 700 S Ste 3
St George, UT 84770-4006 - Phone
- (435) 673-1004
- NPI assigned
- May 31, 2016
- Last updated
- Nov 9, 2021
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 11799232-1206 | UT | Primary |
Addresses
Primary practice location
640 E 700 S Ste 3
St George, UT 84770-4006
Mailing address
PO Box 236
Orderville, UT 84758-0236
Phone (909) 725-6271
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| XXX | Medicaid | UT |
Other names 1
- Alexandros John Pavlides
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11799232-1206 | UT | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hautoa Enterprises LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
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- NPI 1407367345
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1464652800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636416000000",
"number": "1497103485",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 236",
"city": "ORDERVILLE",
"state": "UT",
"postal_code": "847580236",
"telephone_number": "909-725-6271"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "640 E 700 S STE 3",
"city": "ST GEORGE",
"state": "UT",
"postal_code": "847704006",
"telephone_number": "435-673-1004"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAVLIDES",
"first_name": "ALEXANDROS",
"middle_name": "JOHN",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-05-31",
"last_updated": "2021-11-09",
"certification_date": "2021-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "UT",
"license": "11799232-1206",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "XXX",
"state": "UT"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "ALEXANDROS",
"last_name": "PAVLIDES",
"middle_name": "JOHN",
"credential": "P.A.",
"code": "5",
"type": "Other Name"
}
]
}Other providers in St George, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.