DR. OVICTOR LEO ROLDAN TESORO M.D.
NPI 1356584759
Psychiatry & Neurology - Neurology with Special Qualifications in Child Neurology in Phoenix, AZ
About Dr. Ovictor Leo Roldan Tesoro M.d. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. OVICTOR LEO ROLDAN TESORO M.D. (NPI 1356584759) is an individual neurology with special qualifications in child neurology provider in Phoenix, Arizona, licensed in Arizona (47955) and active in the NPI registry since April 2009. He is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Dr. Ovictor Leo Roldan Tesoro M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Ovictor Leo Tesoro reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Winner, SD 57580
- Reassigned Medicare billing, South Dakota enrollment
- 1,277 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 85008 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
PHOENIX, AZ 85008
PHOENIX, AZ 85008
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 Ovictor Leo Tesoro's NPI number?
The NPI number for Ovictor Leo Tesoro is 1356584759. It was assigned to this individual provider in the NPPES registry on April 14, 2009.
Where is Ovictor Leo Tesoro located?
Ovictor Leo Tesoro practices at 2601 E Roosevelt St, Phoenix, AZ 85008. The listed phone number is (602) 344-5011.
What is Ovictor Leo Tesoro's specialty?
The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Neurology with Special Qualifications in Child Neurology, with taxonomy code 2084N0402X.
Is Ovictor Leo Tesoro enrolled in Medicare?
Yes. Ovictor Leo Tesoro is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Ovictor Leo Tesoro's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Ovictor Leo Tesoro reassigns Medicare benefits to Avera Mckennan (Winner, SD). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Ovictor Leo Tesoro's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Ovictor Leo Tesoro accept?
Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from Sunflower Health Plan, Avera Health Plans and Wellmark Health Plan of Iowa, Inc. and 1 other insurer list Ovictor Leo Tesoro as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Ovictor Leo Tesoro was last updated on March 9, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years 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.
# Dr. Ovictor Leo Roldan Tesoro, M.D. · NPI 1356584759
Neurology with Special Qualifications in Child Neurology physician in Phoenix, Arizona. Individual provider, active in the CMS NPPES registry since April 14, 2009.
## Identity
- **NPI:** 1356584759 (Entity type: Individual)
- **Enumerated:** April 14, 2009
- **Primary specialty:** Psychiatry & Neurology - Neurology with Special Qualifications in Child Neurology · taxonomy 2084N0402X
- **State license:** 47955 (Arizona)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 2601 E ROOSEVELT ST, Phoenix, AZ 85008-4973
- **Phone:** (602) 344-5011
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Avera Mckennan (NPI 1912959495, Winner, SD), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** March 9, 2015
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Source: [NPI Profile](https://npiprofile.com/npi/1356584759) · Data from the CMS NPPES public registry.