Peter Su MD LLC

Primary specialty

Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X

Legal business name

PETER SU MD LLC

Practice address

9260 W Sunset Rd Ste 306
Las Vegas, NV 89148-4903

Phone

(702) 779-3994

Fax

(888) 464-0838

NPI assigned

Oct 12, 2021

Last updated

Oct 25, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Peter Su, MDNPI 1164721627

Title

Ceo

Phone

(702) 789-9698

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NV

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Peter Shao You Su, M.D.

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Las Vegas, NV
  • NPI 1164721627
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1633996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698192000000",
    "number": "1073275566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8545 W. WARM SPRINGS ROAD",
            "address_2": "SUITE A-4 #396",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89113",
            "telephone_number": "702-789-9698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9260 W SUNSET RD STE 306",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891484903",
            "telephone_number": "702-779-3994",
            "fax_number": "888-464-0838"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2863 Saint Rose Pkwy",
            "address_purpose": "LOCATION",
            "city": "Henderson",
            "state": "NV",
            "postal_code": "890524806",
            "country_code": "US",
            "telephone_number": "702-779-3994",
            "fax_number": "888-428-0838",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6420 Spring Mountain Rd Ste 17",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891468835",
            "country_code": "US",
            "telephone_number": "702-779-3994",
            "fax_number": "888-464-0838",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PETER SU MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-12",
        "last_updated": "2023-10-25",
        "certification_date": "2023-10-25",
        "status": "A",
        "authorized_official_last_name": "SU",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "702-789-9698",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeannie Tolina Petelo
• Peter a Mansky MD Consultant LTD (Clinical Services of Nevada)
• Peter G. Vajtai, M.D., LTD.
• Peter J Bregman, D.P.M. PLLC (Bregman Foot-Ankle and Nerve Center)
• Peter Raymond Randall (Randall Chiropractic and Rehabilitation)
• Cheyenne Alberta Peter, LPN
• Enobong Peter
• Precious Peter
• Denise Michelle Peterkin
• Ahmad Peters

• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.