GREGORY RICHARD TOLLEFSBOL (PA-C) – Physician Assistant, NPI 1487874624

GREGORY RICHARD TOLLEFSBOL (PA-C) is a healthcare provider. based in Desoto, Texas. specializing in PHYSICIAN ASSISTANT. They hold the professional credentials PA-C. They hold a License No. PA02058 (TX). The NPI Number for GREGORY RICHARD TOLLEFSBOL (PA-C) is 1487874624

Main info

Male
29 Years Of Experience
Accepts Medicare Assignment
Name
GREGORY RICHARD TOLLEFSBOL (PA-C)
NPI
1487874624
Phone
(972) 296-8888
Address
2701 PRINCE GEORGE AVE
Enumeration Date
30 April 2007
Last Update Date
5 November 2007

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
1997 (29 years ago)
PAC ID
0749447472
Group Practice PAC ID
1355254210
Professional Enrollment ID
I20120207000628
Address ID
TX752461608DA4001XSTXX300
Telehealth
Yes
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

8,491 PHYSICIAN ASSISTANT in TX

Provider Addresses for GREGORY RICHARD TOLLEFSBOL (PA-C)

  • 2701 PRINCE GEORGE AVE

    SUITE 100

    DESOTO, TX 751152045

    Phone: (972) 296-8888

    Fax: (972) 780-9550

    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)

CMS reports 1 Open Payments records for all available years, with a total value of $22.

Total Amount is formed as General ($22) + Research ($0) + Ownership ($0) = $22.

Last reported payment date: 2023-08-29 • Largest payer in this snapshot: GlaxoSmithKline, LLC. ($22).

Total Amount

$22

General + Research + Ownership

Payments

1

Total payment records

General Amount

$22

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-08-29

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
GlaxoSmithKline, LLC.$22
View all Open Payments →|Open Payments Risk Radar →

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: 2012-02-07

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
I20120207000628IPhysician AssistantTXTBD

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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99213Established patient office or other outpatient visit, 20-29 minutes9786$0
99214Established patient office or other outpatient visit, 30-39 minutes6962$0
36415Insertion of needle into vein for collection of blood sample4640$0
G0439Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit2323$0
81003Automated urinalysis test1412$0
View full utilization report →

Insurance plans in this area (ZIP 75115)

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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: 1355254210View full group profile
NameSpecialtyState
Radiation OncologyTX
Nurse PractitionerTX
Internal MedicineTX
-TX
-TX
Clinical Social WorkerTX
-TX
Nurse PractitionerTX
Orthopedic SurgeryTX
Clinical PsychologistTX

Reviews

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Frequently asked questions

What is the registry number for GREGORY RICHARD TOLLEFSBOL (PA-C)?
The registry entry for GREGORY RICHARD TOLLEFSBOL (PA-C) shows NPI 1487874624.
Is GREGORY RICHARD TOLLEFSBOL (PA-C) currently accepting referrals based on NPI status?
Registry metadata lists GREGORY RICHARD TOLLEFSBOL (PA-C) as active.
How should patients interpret GREGORY RICHARD TOLLEFSBOL (PA-C)'s specialty?
The extract shows Physician Assistant for GREGORY RICHARD TOLLEFSBOL (PA-C). Clinical services aligned with this taxonomy classification.
What geographic area is tied to GREGORY RICHARD TOLLEFSBOL (PA-C)?
GREGORY RICHARD TOLLEFSBOL (PA-C) is associated with Desoto, Texas in the same public data insurers reference.
Can I export GREGORY RICHARD TOLLEFSBOL (PA-C)'s record?
You can download the official NPPES record; we summarize key fields for readability.

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