Active NPI
Brian Thomas Pekarek, DPM
- Foot & Ankle Surgery Podiatrist
- North Las Vegas, NV
National Provider Identifier
1538108675
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Foot & Ankle Surgery Podiatrist
- License
- 304113
- Practice address
- 6900 N Pecos Rd
North Las Vegas, NV 89086-4400 - Phone
- (702) 791-9000
- NPI assigned
- Jun 5, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | 278 | AL | |
| Podiatrist | 213E00000X | E5177 | CA | |
| Foot & Ankle Surgery Podiatrist | 213ES0103X | 278 | AL | |
| Foot & Ankle Surgery Podiatrist | 213ES0103X | 36 003501 | OH | |
| Foot & Ankle Surgery Podiatrist | 213ES0103X | 304113 | LA | Primary |
Addresses
Primary practice location
6900 N Pecos Rd
North Las Vegas, NV 89086-4400
Mailing address
47 Penny LN Ste 1
Watsonville, CA 95076-6055
Phone (831) 728-8844
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 051556220 | Medicaid | AL | |
| CH5179 | Other | OH | RR MEDICARE GROUP |
| 1563848 | Other | OH | MEDICAID GROUP |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 278 | AL | MD | Podiatrist |
| E5177 | CA | MD | Podiatrist |
| 36 003501 | OH | MD | Foot & Ankle Surgery Podiatrist |
| 5177 | CA | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Podiatry Group Inc | Podiatrist | Past | Accepting new patients |
| Ksu Foot & Ankle Clinic | Podiatrist | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Podiatrist
- Independence, OH
- NPI 1265793111
-
- Podiatrist
- McComb, MS
- NPI 1689096612
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149465600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721692800000",
"number": "1538108675",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "47 PENNY LN STE 1",
"city": "WATSONVILLE",
"state": "CA",
"postal_code": "950766055",
"telephone_number": "831-728-8844",
"fax_number": "831-763-1001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6900 N PECOS RD",
"city": "NORTH LAS VEGAS",
"state": "NV",
"postal_code": "890864400",
"telephone_number": "702-791-9000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEKAREK",
"first_name": "BRIAN",
"middle_name": "THOMAS",
"credential": "DPM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-05",
"last_updated": "2024-07-23",
"certification_date": "2024-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "AL",
"license": "278",
"primary": false
},
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "CA",
"license": "E5177",
"primary": false
},
{
"code": "213ES0103X",
"taxonomy_group": "",
"desc": "Podiatrist, Foot & Ankle Surgery",
"state": "AL",
"license": "278",
"primary": false
},
{
"code": "213ES0103X",
"taxonomy_group": "",
"desc": "Podiatrist, Foot & Ankle Surgery",
"state": "OH",
"license": "36 003501",
"primary": false
},
{
"code": "213ES0103X",
"taxonomy_group": "",
"desc": "Podiatrist, Foot & Ankle Surgery",
"state": "LA",
"license": "304113",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "051556220",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE GROUP",
"identifier": "CH5179",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAID GROUP",
"identifier": "1563848",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}
Other providers in North Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.