Mark Steven Peterson, MD

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

MD16135 Issued in OR

Practice address

925 Commercial St SE Ste 102
Salem, OR 97302-4173

Phone

(503) 561-7227

Fax

(503) 671-8334

NPI assigned

Nov 20, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Salem Vascular Consultants, LLP

  • Vascular Surgery Physician
  • Salem, OR
  • NPI 1508074147
  NPD (past)
• Salem Vascular, PC

  • Vascular Surgery Physician
  • Salem, OR
  • NPI 1831411560
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602028800000",
    "number": "1003980053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "925 COMMERCIAL ST SE STE 102",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973024173",
            "telephone_number": "503-561-7227",
            "fax_number": "503-371-8334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 COMMERCIAL ST SE STE 102",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973024173",
            "telephone_number": "503-561-7227",
            "fax_number": "503-671-8334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "MARK",
        "middle_name": "STEVEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-20",
        "last_updated": "2020-10-07",
        "certification_date": "2020-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "OR",
            "license": "MD16135",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010509",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mark.peterson.wvs@direct.wvp.nextgenshare.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "925 Commercial St SE Ste 102",
            "city": "Salem",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973024173",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Amara Lenore Peterson
• Christina Marie Peterson, R.D.H
• Diana Peterson, M.S, CCC-A
• Jessica Peterson, RD
• Jodi Leann Peterson, RN
• Maudie Alice Peterson, MS,LPC
• McKenzie Peterson
• Patricia E Peterson, M.D.
• Richard L Peterson, DC
• Shane Ember Peterson, M.D.

• Vascular Surgery Physician in Salem, OR
• Providers in Salem, OR by specialty
• Vascular Surgery Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.