Emily Becker Pevtsov, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-07412 Issued in NC

Practice address

548 Sandhurst Dr
Fayetteville, NC 28304-4426

Phone

(910) 484-3400

Fax

(910) 484-3404

NPI assigned

Oct 9, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Emily Frances Becker Former name

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Midwestern University, Chicago College of Osteopathic Med, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Blooming Medical Group, PLLCGroup PAC ID 7113312364, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Blooming Medical Group, PLLC

  • Physician Assistant
  • Cary, NC
  • NPI 1750041497
  Medicare reassignment Care Compare group Authorized official

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

{
    "created_epoch": "1412812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1679977391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "548 SANDHURST DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283044426",
            "telephone_number": "910-484-3400",
            "fax_number": "910-484-3404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "548 SANDHURST DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283044426",
            "telephone_number": "910-484-3400",
            "fax_number": "910-484-3404"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1460 Bond St",
            "address_2": "Suite 130",
            "address_purpose": "LOCATION",
            "city": "Naperville",
            "state": "IL",
            "postal_code": "605636502",
            "country_code": "US",
            "telephone_number": "630-859-0120",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PEVTSOV",
        "first_name": "EMILY",
        "middle_name": "BECKER",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-10-09",
        "last_updated": "2022-07-21",
        "certification_date": "2020-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.005271",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-07412",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EMILY",
            "last_name": "BECKER",
            "middle_name": "FRANCES",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Audrey Petteruti, DO
• Josie Lynn Pettipiece, MS, CCC-SLP
• Natifa Pettus, LCSW
• Angela D Petty, LMFT
• Maggie Marie Petty, DPT
• Yonesha Val Phair, D.D.S
• My Pham, PHARMD
• Telisa Dawn Pharris, MSW, LCSWA, LCASA
• Phases Recovery Community PLLC
• PHCP

• Physician Assistant in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.