NPIMap

Individual provider Active NPI

Robert Peteris Vickerman, MD

  • Surgery Physician
  • Greeley, CO
National Provider Identifier
1023085511
Registry record updated Mar 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
47459 Issued in CO
Practice address
1800 15TH St
Suite 210
Greeley, CO 80631-4500
Phone
(970) 352-8216
Fax
(970) 352-5297
NPI assigned
Mar 2, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 29, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Trauma Surgery Physician 2086S0127X 34611 TN
Surgery Physician 208600000X 47459 CO Primary

Addresses

Primary practice location

1800 15TH St
Suite 210
Greeley, CO 80631-4500

Mailing address

1800 15TH St
Suite 210
Greeley, CO 80631-4500
Phone (970) 352-8216

Other identifiers 1

IdentifierTypeStateIssuer
3858329MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100126000675 CO Practitioner - General Surgery 1850364795 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Wisconsin School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1800 15TH St
Greeley, CO 80631-4563

1801 16TH St
Greeley, CO 80631-5154
Phone (970) 810-4121

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)22
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux12
Melanoma (skin cancer) excision1-10
Removal of tissue12

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
47459COMDSurgery Physician
34611TNMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Health Physicians Colorado LLC CurrentSince Jan 1, 2012 Accepting new patients
Banner Health Physicians Colorado LLC CurrentSince Jan 1, 2012 Accepting new patients
North Colorado Medical Center Past Accepting new patients
Banner Greeley Specialists Past Accepting new patients
Banner Health Physicians Colorado LLC Past Accepting new patients

Locations

1801 16th St
Greeley, CO 80631
Phone (970) 352-4121

1800 15th St
Ste 210
Greeley, CO 80631
Phone (970) 352-8216

1801 16th St
Ste C2B
Greeley, CO 80631
Phone (970) 810-4121

1800 15th St
Ste 200
Greeley, CO 80631
Phone (970) 348-0020

Networks

  • CO HMO D-SNP
  • CO HMO
  • devoted network organization-a4751131-f16f-4e82-8f2b-b08e66379a7a

Organizations & group practices 5

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.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1141257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1269820800000",
    "number": "1023085511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 15TH ST",
            "address_2": "SUITE 210",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806314500",
            "telephone_number": "970-352-8216",
            "fax_number": "970-352-5297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 15TH ST",
            "address_2": "SUITE 210",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806314500",
            "telephone_number": "970-352-8216",
            "fax_number": "970-352-5297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICKERMAN",
        "first_name": "ROBERT",
        "middle_name": "PETERIS",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-02",
        "last_updated": "2010-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "TN",
            "license": "34611",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CO",
            "license": "47459",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3858329",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greeley, CO

Sources for this page

Verify at the official NPI Registry.