Predrag Pavlovic, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

DR0055445 Issued in CO

Practice address

1624 S 21St St Ste B
Colorado Springs, CO 80904-4296

Phone

(719) 955-3621

NPI assigned

Mar 20, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Arc Therapy Services LLC

  • Community Based Hospice Care Agency
  • Greenwood Village, CO
  • NPI 1518276336

  Contracted Managing Employee

  CMS ownership

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.

• Peak Vista Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Colorado Springs, CO
  • NPI 1730166034
  Medicare reassignment NPD
• Peak Vista Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Colorado Springs, CO
  • NPI 1871347443
  NPD
• DRH Medical Group

  • Urgent Care Clinic/Center
  • Oakland, CA
  • NPI 1790560225
  NPD (past)

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

{
    "created_epoch": "1269043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638316800000",
    "number": "1659695625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1624 S 21ST ST STE B",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809044296",
            "telephone_number": "719-955-3621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1624 S 21ST ST STE B",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809044296",
            "telephone_number": "719-955-3621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAVLOVIC",
        "first_name": "PREDRAG",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-03-20",
        "last_updated": "2021-12-01",
        "certification_date": "2021-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "N5327",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "005929",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "DR0055445",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "52271722",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NUMBER",
            "identifier": "428866YKRD",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dale L Pavek, D.D.S.
• Virginia Paver, APN
• Elena Pavlenko, RN
• Peter Pavlick, RPH
• Jeremy Jon Pavlik, QBHA/PRC
• Maria Pawlik, MSSW, LCSW
• Cherll Paxton, MA, NCC
• Paxxon Healthcare Services LLC
• Maria Del Sagrario Payares Arevalo
• Ryan Payeur

• Family Medicine Physician in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Family Medicine Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.