Dr Ted Kovacev MD PA

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

DR TED KOVACEV MD PA

Practice address

104 Circle Way St Ste a
Lake Jackson, TX 77566-5200

Phone

(979) 721-7007

Fax

(979) 721-4254

NPI assigned

Sep 26, 2019

Last updated

May 4, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Diane Brooke Kovacev

Title

Practice Manager

Phone

(979) 721-7007

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ted Kovacev MD Other name

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ted Armstrong Kovacev, MD

  • Surgery Physician
  • Lake Jackson, TX
  • NPI 1568614402
  Medicare reassignment NPD

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

{
    "created_epoch": "1569456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651622400000",
    "number": "1588215933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 CIRCLE WAY ST STE A",
            "city": "LAKE JACKSON",
            "state": "TX",
            "postal_code": "775665200",
            "telephone_number": "979-721-7007",
            "fax_number": "979-721-4254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 CIRCLE WAY ST STE A",
            "city": "LAKE JACKSON",
            "state": "TX",
            "postal_code": "775665200",
            "telephone_number": "979-721-7007",
            "fax_number": "979-721-4254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR TED KOVACEV MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-26",
        "last_updated": "2022-05-04",
        "certification_date": "2022-05-04",
        "status": "A",
        "authorized_official_last_name": "KOVACEV",
        "authorized_official_first_name": "DIANE",
        "authorized_official_middle_name": "BROOKE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "979-721-7007",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4042707-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ted Kovacev MD",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Ted Kovacev MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Surgery Physician in Lake Jackson, TX
• Providers in Lake Jackson, TX by specialty
• Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.