Active NPI
Samuel H Perrry II, M.D.
- Pediatrics Physician
- North Platte, NE
National Provider Identifier
1043244098
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 12525
- Practice address
- 210 McNeel LN
North Platte, NE 69101-6290 - Phone
- (308) 534-9230
- Fax
- (308) 534-5016
- NPI assigned
- Jul 10, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 12525 | NE | Primary |
Addresses
Primary practice location
210 McNeel LN
North Platte, NE 69101-6290
Mailing address
410 Seagull Dr
North Platte, NE 69101-8910
Phone (308) 534-9230
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 47068774800 | Medicaid | NE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12525 | NE | MD | Pediatrics Physician |
Interoperability endpoints
- https://api.platform.athenahealth.com/7862/brand/1/csg/1/fhir/r4
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1043244098",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "410 SEAGULL DR",
"city": "NORTH PLATTE",
"state": "NE",
"postal_code": "691018910",
"telephone_number": "308-534-9230",
"fax_number": "308-534-5016"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 MCNEEL LN",
"city": "NORTH PLATTE",
"state": "NE",
"postal_code": "691016290",
"telephone_number": "308-534-9230",
"fax_number": "308-534-5016"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERRRY",
"first_name": "SAMUEL",
"middle_name": "H",
"name_prefix": "Dr.",
"name_suffix": "II",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NE",
"license": "12525",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "47068774800",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in North Platte, NE
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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.