Gregory A Peco, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA04031 Issued in TX

Practice address

5915 La Crosse Ave Ste 140
Austin, TX 78739-1783

Phone

(512) 877-5333

Fax

(503) 954-2122

NPI assigned

Jul 10, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Central Texas Community Health Centers

  dba CommUnityCare--Southeast Health & Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Austin, TX
  • NPI 1861420382
  NPD (past)
• Texas Pediatric Clinic

  • Primary Care Clinic/Center
  • Houston, TX
  • NPI 1295041820
  NPD (past)
• Pacific Crest Childrens Urgent Care LLC

  dba Brave Care

  • Urgent Care Clinic/Center
  • Portland, OR
  • NPI 1164947701
  NPD (past)

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

{
    "created_epoch": "1215648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668643200000",
    "number": "1679737431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5915 LA CROSSE AVE STE 140",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787391783",
            "telephone_number": "512-877-5333",
            "fax_number": "503-954-2122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5915 LA CROSSE AVE STE 140",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787391783",
            "telephone_number": "512-877-5333",
            "fax_number": "503-954-2122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PECO",
        "first_name": "GREGORY",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-10",
        "last_updated": "2022-11-17",
        "certification_date": "2022-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA04031",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1295041820",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cristina Peck, MA
• Kelton D Peck, PHARMD
• Kimberly Peck, RD, CDN
• Melissa Peck, L.AC.
• Moe Peck, PH.D,ATR,LPC
• Lakshmi Peddu, RDN
• Annelisa Helene Pedersen, PHD
• Lady Carolina Pedersen, LMFT
• Sue Snyder Pederson, MSSW LCSW
• Pedi Spot LLC

• Physician Assistant in Austin, TX
• Providers in Austin, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.