Active NPI
Charles Edward Pechous III, DDS
- Prosthodontics
- Kenosha, WI
National Provider Identifier
1518089523
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 4535 - 015
- Practice address
- 6124 Sheridan Rd
Kenosha, WI 53143-4527 - Phone
- (262) 654-2423
- NPI assigned
- Apr 3, 2007
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 4535 - 015 | WI | Primary |
Addresses
Primary practice location
6124 Sheridan Rd
Kenosha, WI 53143-4527
Mailing address
7202 3Rd Ave
Kenosha, WI 53143-5561
Phone (262) 764-0261
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: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jun 27, 2016 through Jun 27, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4535 - 015 | WI | MD | Prosthodontist |
| 4535 | WI | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1518089523",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7202 3RD AVE",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531435561",
"telephone_number": "262-764-0261"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6124 SHERIDAN RD",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531434527",
"telephone_number": "262-654-2423"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PECHOUS",
"first_name": "CHARLES",
"middle_name": "EDWARD",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "WI",
"license": "4535 - 015",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kenosha, WI
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.