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DEVIANNA GUNAWAN-PON NP
NPI 1174477749
Nurse Practitioner - Family in Suwanee, GA

Active since February 23, 2026PECOS Enrolled
1460 DISTRIBUTION DR APT 5106, SUWANEE, GA 30024(850) 490-1138 Get Directions Write a Review

NPPES record last updated: February 23, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Devianna Gunawan-pon Np NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DEVIANNA GUNAWAN-PON NP (NPI 1174477749) is an individual family provider in Suwanee, Georgia, licensed in Georgia (F02260479) and active in the NPI registry since February 2026. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1174477749
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameDEVIANNA GUNAWAN-PONCredential: NP
Location Address1460 DISTRIBUTION DR APT 5106Suwanee, GA 30024-4390
Mailing Address1460 Distribution Dr Apt 5106Suwanee, GA 30024-4390
Phone(850) 490-1138
Sole ProprietorNo
Enumeration DateFebruary 23, 2026
NPPES CertifiedFebruary 22, 2026
✔ NPI 1174477749 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in GA · F02260479
1460 DISTRIBUTION DR APT 5106, Suwanee, GA 30024
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Devianna Gunawan-pon Np is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 30024 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$88.06 typical visit price
range $56.84 – $172.43
Typical copayment $22.01 (range $14.21 – $43.10)
Most-billed visit code 99203
Established Patient
$100.20 typical visit price
range $18.22 – $140.40
Typical copayment $25.05 (range $4.55 – $35.10)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Devianna Gunawan-pon's NPI number?

The NPI number for Devianna Gunawan-pon is 1174477749. It was assigned to this individual provider in the NPPES registry on February 23, 2026.

Where is Devianna Gunawan-pon located?

Devianna Gunawan-pon practices at 1460 Distribution Dr Apt 5106, Suwanee, GA 30024. The listed phone number is (850) 490-1138.

What is Devianna Gunawan-pon's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Devianna Gunawan-pon enrolled in Medicare?

Yes. Devianna Gunawan-pon is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Devianna Gunawan-pon was last updated on February 23, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.