Gerald Bernard Pevow, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

28268 Issued in TX

Practice address

1802 W Anderson LN
Austin, TX 78757-1338

Phone

(512) 459-4347

Fax

(512) 459-4348

NPI assigned

Sep 12, 2012

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

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• US Health Dept of Health & Human Services

  • Rural Health Clinic/Center
  • Poplar, MT
  • NPI 1972694602

  TX

  Medicare reassignment NPD
• U S Health Dept of Health & Human Services

  dba Lodge Grass Clinic

  • Critical Access Hospital
  • Lodge Grass, MT
  • NPI 1750410395
  NPD
• US Health Dept of Health & Human Services

  dba Crow/Northern Cheyenne Hospital

  • Critical Access Hospital
  • Crow Agency, MT
  • NPI 1548393358
  NPD

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

{
    "created_epoch": "1347408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623888000000",
    "number": "1558611087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1802 W ANDERSON LN",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787571338",
            "telephone_number": "512-459-4347",
            "fax_number": "512-459-4348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1802 W ANDERSON LN",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787571338",
            "telephone_number": "512-459-4347",
            "fax_number": "512-459-4348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEVOW",
        "first_name": "GERALD",
        "middle_name": "BERNARD",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-09-12",
        "last_updated": "2021-06-17",
        "certification_date": "2021-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "28628",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "28268",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Monroe Pettry, REGISTERED DIETITIAN
• Amela Rizvic Petty
• Bryn Petty, SLP
• Faraji Petty
• Gabriel Lewis Petty, PA
• Pevzner DDS PLLC
• Alexandria Peynado
• Kathleen Pezan
• Margaret Pfaff
• Donna Pfeffer, MED, LPC

• General Practice Dentistry in Austin, TX
• Providers in Austin, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2021; 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.