Jeremiah Daniel Pavelka, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

69466 Issued in AZ

Practice address

1500 S Main St
Fort Worth, TX 76104-4917

Phone

(817) 702-8840

NPI assigned

Mar 22, 2019

Last updated

Aug 5, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in TX, AZ2 enrollments

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 2

Specialty

Emergency Medicine

Education

University of Nevada School of Medicine, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Chandler Emergency Medical Group LLCGroup PAC ID 1658272968, 47 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Chandler Regional Medical Center Hospital, Chandler, AZ, CCN 030036
• Mercy Gilbert Medical Center Hospital, Gilbert, AZ, CCN 030119

Merit-based Incentive Payment System (MIPS)

Final score

85.77 of 100Reported as group

Quality

81.6

Improvement activities

40

Cost

77.61

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Chandler Emergency Medical Group, LLC

  dba Premier Emergency Medical Specialists

  • Emergency Medicine Physician
  • Chandler, AZ
  • NPI 1104871961

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Integrative Emergency Services Physician Group PA

  • Emergency Medicine Physician
  • Fort Worth, TX
  • NPI 1285922542

  Single Specialty

  Medicare reassignment NPD
• Cep America- Arizona, PC

  • Emergency Medicine Physician
  • Chandler, AZ
  • NPI 1780202804

  Single Specialty

  Medicare reassignment NPD
• Progressive Medical Associates PLLC

  • Emergency Medicine Physician
  • Mesa, AZ
  • NPI 1548218613

  Single Specialty

  Medicare reassignment NPD
• Cep America - Arizona PC

  • Emergency Medicine Physician
  • Mesa, AZ
  • NPI 1356021190
  NPD
• Cep America-Arizona, PC

  dba Vituity

  • Emergency Medicine Physician
  • Sun City, AZ
  • NPI 1306210224
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Dignity Community Care

  dba Chandler Regional Medical Center

  • General Acute Care Hospital
  • Chandler, AZ
  • NPI 1700910189
  Care Compare affiliation
• Dignity Health

  dba Mercy Gilbert Medical Center

  • General Acute Care Hospital
  • Gilbert, AZ
  • NPI 1992735088
  Care Compare affiliation

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

{
    "created_epoch": "1553212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691193600000",
    "number": "1902366370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1744 E EVERGREEN ST",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852035802",
            "telephone_number": "702-281-7873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 S MAIN ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044917",
            "telephone_number": "817-702-8840"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1400 S Dobson Rd",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "85202",
            "country_code": "US",
            "telephone_number": "702-281-7873",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PAVELKA",
        "first_name": "JEREMIAH",
        "middle_name": "DANIEL",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-03-22",
        "last_updated": "2023-08-05",
        "certification_date": "2023-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "T2715",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AZ",
            "license": "69466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shejuti Paul, MD
• Ariel Carolanne Paulson, LCDC-I
• Scott Christian Paulson, LCSW
• Anita Misra Paulus, D.D.S.P,C
• William George Paulus, DDS
• Arthur S Pawgan, MD
• Ronnie Clinton Pawley, DPT
• Paul Payberah, PA
• Amber L Payne, PAC
• Athena Marie Payne, D.C.

• Emergency Medicine Physician in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Emergency Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2023; 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.