DONALD PESAVENTO (M.D.) – Family Medicine Physician, NPI 1104843937

DONALD PESAVENTO (M.D.) is a healthcare provider. based in Crown point, Indiana. specializing in GENERAL SURGERY. They hold the professional credentials M.D.. They hold a License No. 01032265A (IN). The NPI Number for DONALD PESAVENTO (M.D.) is 1104843937

Main info

Male
Sole Proprietor
49 Years Of Experience
Accepts Medicare Assignment
Name
DONALD PESAVENTO (M.D.)
NPI
1104843937
Phone
(219) 756-2100
Address
9301 CONNECTICUT DRIVE
Enumeration Date
17 July 2006
Last Update Date
19 July 2011

Doctor Profile

Medical School Name
NORTHWESTERN UNIVERSITY FEINBERG MEDICAL SCHOOL
Secondary Phone
-
Graduation Year
1977 (49 years ago)
PAC ID
2264468867
Group Practice PAC ID
1254331184
Professional Enrollment ID
I20050714000932
Address ID
IN464107173ME9301XDRXX300
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience57
Completeness75
Years active:19State licenses:1Digital endpointsOther names

729 GENERAL SURGERY in IN

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Provider Addresses for DONALD PESAVENTO (M.D.)

  • Crown Point, Collinsville, Canton, Hartford County, Connecticut, 06019, United States

    CROWN POINT, IN 463077486

    Phone: (219) 756-2100

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

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: 2005-07-14

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

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20050714000932IGeneral SurgeryINTBD

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.

Verify on CMS Revalidation Lookup Tool

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.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 46307)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 1254331184View full group profile
NameSpecialtyState
Nurse PractitionerIN
O B S T E T R I C S/ G Y N E C O L O G YIN
Nurse PractitionerIN
Nurse PractitionerIN

Reviews

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Frequently asked questions

How do payers reference DONALD PESAVENTO (M.D.)?
For DONALD PESAVENTO (M.D.), use NPI 1104843937 as the unique 10-digit identifier.
Would DONALD PESAVENTO (M.D.) appear as active to a payer?
You can treat DONALD PESAVENTO (M.D.) as active for directory purposes; confirm clinical privileges separately.
How would a patient describe DONALD PESAVENTO (M.D.)'s focus?
For DONALD PESAVENTO (M.D.), the primary taxonomy reads as Family Medicine Physician. Clinical services aligned with this taxonomy classification.
What practice footprint exists for DONALD PESAVENTO (M.D.)?
Travel planning: use Crown Point, Indiana as the reference point for DONALD PESAVENTO (M.D.), then confirm.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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