NPIMap

Individual provider Active NPI

Peter Brooks Koppenheffer, M.D.

  • Family Medicine Physician
  • Greenfield, MA
National Provider Identifier
1053637561
Registry record updated Sep 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
275445 Issued in MA
Practice address
48 Sanderson St
Greenfield, MA 01301
Phone
(413) 773-2022
NPI assigned
Apr 9, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 269392 NY
Family Medicine Physician 207Q00000X 275445 MA Primary

Addresses

Primary practice location

48 Sanderson St
Greenfield, MA 01301

Mailing address

280 Chestnut St FL 2
Springfield, MA 01199-1619
Phone (413) 794-5700

Other practice location 1

118 Main St
Saranac Lake, NY 12983-1705
Phone (518) 891-5000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20180910001110 MA Practitioner - Family Practice 7012162662 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Baystate Medical Practices IncGroup PAC ID 5991602971, 1,350 clinicians

Practice addresses (Care Compare)

48 Sanderson St
Greenfield, MA 01301-2778
Phone (413) 773-2851

Hospital & facility affiliations

  • Care Central Vna & Hospice Inc Home health agency, Gardner, MA, CCN 227003
  • Amedisys Home Health Care Home health agency, Agawam, MA, CCN 227288
  • Encompass Health Home Health Home health agency, Ludlow, MA, CCN 227611
  • Vna & Hospice of Cooley Dickinson Home health agency, Northampton, MA, CCN 227021
  • Overlook Visiting Nurse Association Inc Home health agency, Sunderland, MA, CCN 227443
  • Pioneer Valley Hospice & Palliative Care Hospice, Greenfield, MA, CCN 221561
  • Baystate Franklin Medical Center Hospital, Greenfield, MA, CCN 220016
  • Baystate Medical Center Hospital, Springfield, MA, CCN 220077
  • Cooley Dickinson Hospital Inc,the Hospital, Northampton, MA, CCN 220015
  • Baystate Noble Hospital Hospital, Westfield, MA, CCN 220065

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
275445MAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Baystate Medical Practices, Inc CurrentSince Aug 28, 2018 Accepting new patients

Locations

48 Sanderson St
Greenfield, MA 01301
Phone (413) 773-2022

759 Chestnut St
Springfield, MA 01199
Phone (413) 794-3233

280 Chestnut St
Fl 2
Springfield, MA 01199
Phone (413) 788-4385

Organizations & group practices 1

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 11

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

NPI Registry JSON

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

{
    "created_epoch": "1270771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537315200000",
    "number": "1053637561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "280 CHESTNUT ST FL 2",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011991619",
            "telephone_number": "413-794-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "48 SANDERSON ST",
            "city": "GREENFIELD",
            "state": "MA",
            "postal_code": "01301",
            "telephone_number": "413-773-2022"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "118 Main St",
            "address_purpose": "LOCATION",
            "city": "Saranac Lake",
            "state": "NY",
            "postal_code": "129831705",
            "country_code": "US",
            "telephone_number": "518-891-5000",
            "fax_number": "518-891-2598",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOPPENHEFFER",
        "first_name": "PETER",
        "middle_name": "BROOKS",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-04-09",
        "last_updated": "2018-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "269392",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "275445",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenfield, MA

Sources for this page

Verify at the official NPI Registry.