DEREK PAUL PENDARVIS (MD) – Surgery Physician, NPI 1104806108
Surgery Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,092 GENERAL SURGERY in GA
Provider Addresses for DEREK PAUL PENDARVIS (MD)
743 Spring St NE
Gainesville, GA 305013715
Phone: (770) 536-2323
Fax: (770) 536-4947
Type: Location
1400 River Pl
Braselton, GA 305175600
Phone: (770) 536-2323
Fax: (770) 536-4947
Type: Location
1945 Beverly Rd
Gainesville, GA 305012034
Phone: (770) 536-2323
Fax: (770) 536-4947
Type: Location
1270 Friendship Rd
Braselton, GA 305175630
Phone: (770) 536-2323
Fax: (770) 536-4947
Type: Location
495 Highway 400
Dahlonega, GA 305336823
Phone: (770) 536-2323
Fax: (770) 536-4947
Type: Location
PO BOX 658
GAINESVILLE, GA 305030658
Phone: (770) 718-1122
Fax: (770) 535-7445
Type: Mailing
Longstreet Cancer Center, 725, Jesse Jewell Parkway Southeast, Gainesville, Hall County, Georgia, 30501, United States
GAINESVILLE, GA 305013834
Phone: (770) 536-2323
Fax: (770) 536-4947
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 22 Open Payments records for all available years, with a total value of $954.
Total Amount is formed as General ($954) + Research ($0) + Ownership ($0) = $954.
Last reported payment date: 2024-09-19 • Largest payer in this snapshot: Myriad Genetic Laboratories, Inc. ($301).
Total Amount
$954
General + Research + Ownership
Payments
22
Total payment records
General Amount
$954
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-09-19
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Myriad Genetic Laboratories, Inc. | $301 |
| Aroa Biosurgery Incorporated | $176 |
| Medtronic, Inc. | $127 |
| Boston Scientific Corporation | $117 |
| Ethicon US, LLC | $55 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2010-09-22
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20100922000642 | I | General Surgery | GA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 125 | 125 | $0 |
| 10005 | Fine needle aspiration biopsy using ultrasound guidance, first growth | 108 | 105 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 72 | 70 | $0 |
| 76998 | Ultrasonic guidance during surgery | 52 | 51 | $0 |
| 99203 | New patient office or other outpatient visit, 30-44 minutes | 51 | 51 | $0 |
Insurance plans in this area (ZIP 30501)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| GENERAL SURGERY | GA | 45378 | Diagnostic examination of large bowel using an endoscope | 13 | 13 |
| GENERAL SURGERY | GA | 45385 | Removal of polyps or growths of large bowel using an endoscope | 33 | 33 |
| GENERAL SURGERY | GA | 76942 | Ultrasonic guidance imaging supervision and interpretation for insertion of needle | 17 | 16 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Internal Medicine | GA | |
| Nurse Practitioner | GA | |
| Nurse Practitioner | GA | |
| Family Practice | GA | |
| - | GA | |
| Diagnostic Radiology | GA | |
| O B S T E T R I C S/ G Y N E C O L O G Y | GA | |
| - | GA | |
| Certified Nurse Midwife (Cnm) | GA | |
| General Practice, Pathology | GA |
Reviews
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