Gustavo Pena-Velasco, D.D.S., M.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D10925 Issued in MN

Practice address

3950 Veterans Dr
Suite 100
Saint Cloud, MN 56303-3410

Phone

(320) 252-3611

Fax

(320) 252-7574

NPI assigned

May 23, 2006

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

Enrolled in MN

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

Master of Science

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: gpenavelasco1497@direct.centracare.com

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.

• Centrasota Oral & Maxillofacial Surgeons, P.a.

  • Oral and Maxillofacial Surgery (Dentist)
  • Saint Cloud, MN
  • NPI 1598710477
  Medicare reassignment NPD
• Hennepin Faculty Associates

  • General Practice Physician
  • Minneapolis, MN
  • NPI 1063459485
  NPD (past)

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1300060800000",
    "number": "1851346639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3950 VETERANS DR",
            "address_2": "SUITE 100",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563033410",
            "telephone_number": "320-252-3611",
            "fax_number": "320-252-7574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3950 VETERANS DR",
            "address_2": "SUITE 100",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563033410",
            "telephone_number": "320-252-3611",
            "fax_number": "320-252-7574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENA-VELASCO",
        "first_name": "GUSTAVO",
        "credential": "D.D.S., M.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-23",
        "last_updated": "2011-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MN",
            "license": "D10925",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "976017200",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah Marie Pelletier, APRN
• Rebecca Lynn Pellici
• Jamie Michael Pelzel, MD
• Barbara Viola Pelzer
• Angela Lea Pemberton, CNP
• Laura Elizabeth Pendleton, RN
• Carol Pengshung
• Brianna Perez-Cervantes
• Perimeter Care Inc
• Holly Bacon Perkins, M.D.

• Oral and Maxillofacial Surgery (Dentist) in Saint Cloud, MN
• Providers in Saint Cloud, MN by specialty
• Oral and Maxillofacial Surgery (Dentist) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2011; 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.

Verify at the official NPI Registry.