Active NPI
Peter Augusto Bernardo, M.D
- Surgery Physician
- Salem, OR
National Provider Identifier
1053302943
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 17631
- Practice address
- 700 Bellevue St SE
Suite 230
Salem, OR 97301-3819 - Phone
- (503) 585-6586
- Fax
- (503) 371-4180
- NPI assigned
- Oct 31, 2005
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 17631 | OR | Primary |
Addresses
Primary practice location
700 Bellevue St SE
Suite 230
Salem, OR 97301-3819
Mailing address
700 Bellevue St SE
Suite 230
Salem, OR 97301-3819
Phone (503) 585-6586
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 044458 | Medicaid | OR |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17631 | OR | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130716800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1053302943",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "700 BELLEVUE ST SE",
"address_2": "SUITE 230",
"city": "SALEM",
"state": "OR",
"postal_code": "973013819",
"telephone_number": "503-585-6586",
"fax_number": "503-371-4180"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 BELLEVUE ST SE",
"address_2": "SUITE 230",
"city": "SALEM",
"state": "OR",
"postal_code": "973013819",
"telephone_number": "503-585-6586",
"fax_number": "503-371-4180"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERNARDO",
"first_name": "PETER",
"middle_name": "AUGUSTO",
"name_prefix": "Dr.",
"credential": "M.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-10-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "OR",
"license": "17631",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "044458",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Salem, OR
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.