Active NPI
Carlos Hernandez Pavon
- Dentist
- Columbus, OH
National Provider Identifier
1689417826
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- RES.004849
- Practice address
- 305 W 12TH Ave FL 2
Columbus, OH 43210-1267 - Phone
- (614) 292-2622
- NPI assigned
- Jun 17, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Dentist | 122300000X | RES.004849 | OH | Primary |
Addresses
Primary practice location
305 W 12TH Ave FL 2
Columbus, OH 43210-1267
Mailing address
11802 Reedy Creek Dr Apt 307
Orlando, FL 32836-6821
Phone (407) 764-3698
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240809000201 | OH | Order and Referring Only - Dentist | 8022555994 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1718582400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722729600000",
"number": "1689417826",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11802 REEDY CREEK DR APT 307",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328366821",
"telephone_number": "407-764-3698"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "305 W 12TH AVE FL 2",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432101267",
"telephone_number": "614-292-2622"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERNANDEZ PAVON",
"first_name": "CARLOS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-06-17",
"last_updated": "2024-08-04",
"certification_date": "2024-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OH",
"license": "RES.004849",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbus, OH
- Sarah Perou Hermans, MD
- Heather Grace Hermiller, PMHNP
- Hermona Robinson Tru-Rob Counseling and Consulting (Hermona Robinson Tru-Rob Counseling and Consulting LLC)
- Ilse Hernandez Aguirre, MD, PHD
- Wydalis Hernandez Negron
- Sherea T Hernandez-Rogers
- Christopher Osiel Hernandez, PHARMD
- Deisy N Hernandez
- Jamie Hernandez, DO
- Janie Hernandez, LPCCS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2024; 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.