Active NPI
Danita Lucette Peoples-Peterson, MD
- Dermatology Physician
- Midland, MI
National Provider Identifier
1033219399
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 4301046057
- Practice address
- 5103 Eastman Ave
Suite 255
Midland, MI 48640 - Phone
- (989) 832-7915
- Fax
- (989) 832-7915
- NPI assigned
- Sep 25, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 4301046057 | MI | Primary |
Addresses
Primary practice location
5103 Eastman Ave
Suite 255
Midland, MI 48640
Mailing address
5103 Eastman Ave
Suite 255
Midland, MI 48640
Phone (989) 832-7915
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DP046057 | Other | BLUE CROSS BLUE SHIELD MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 1, 2007 through Jan 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1033219399",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5103 EASTMAN AVE",
"address_2": "SUITE 255",
"city": "MIDLAND",
"state": "MI",
"postal_code": "48640",
"telephone_number": "989-832-7915",
"fax_number": "989-832-0080"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5103 EASTMAN AVE",
"address_2": "SUITE 255",
"city": "MIDLAND",
"state": "MI",
"postal_code": "48640",
"telephone_number": "989-832-7915",
"fax_number": "989-832-7915"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEOPLES-PETERSON",
"first_name": "DANITA",
"middle_name": "LUCETTE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "MI",
"license": "4301046057",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD MI",
"identifier": "DP046057",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Midland, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.