Andrew Clair Peterson, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MDO9438 Issued in OR

Practice address

1050 SW 3Rd Ave
#3200
Ontario, OR 97914-2193

Phone

(541) 881-7373

Fax

(541) 881-7186

NPI assigned

Apr 13, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Apogee Medical Group PC

  • Internal Medicine Physician
  • Phoenix, AZ
  • NPI 1558302174

  OR

  Medicare reassignment NPD
• Apogee Medical Group PC

  • Internal Medicine Physician
  • Astoria, OR
  • NPI 1841461803
  NPD
• Apogee Medical Group PC

  • Internal Medicine Physician
  • Phoenix, AZ
  • NPI 1922279991
  NPD
• Saint Alphonsus Medical Center- Ontario Inc

  • Internal Medicine Physician
  • Ontario, OR
  • NPI 1093034159
  NPD (past)

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

{
    "created_epoch": "1144886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1233705600000",
    "number": "1093779365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 SW 3RD AVE",
            "address_2": "#3200",
            "city": "ONTARIO",
            "state": "OR",
            "postal_code": "979142193",
            "telephone_number": "541-881-7373",
            "fax_number": "541-881-7186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 SW 3RD AVE",
            "address_2": "#3200",
            "city": "ONTARIO",
            "state": "OR",
            "postal_code": "979142193",
            "telephone_number": "541-881-7373",
            "fax_number": "541-881-7186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "ANDREW",
        "middle_name": "CLAIR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-13",
        "last_updated": "2009-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MDO9438",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ID",
            "license": "M6155",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003390300",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "153049",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexandro A Pedroza, B.A.
• Amanda Pelayo, RMA
• Janette Lynn Pennington, CSWA
• Samantha Drey Perdue, QMHA
• Ashley Petersen
• Benjamin T Peterson, DDS
• Randolph E Peterson, MD
• Ashlee Nicole Petty
• Jeffrey F Phillips, MD
• John H Phillips, M.D.

• Internal Medicine Physician in Ontario, OR
• Providers in Ontario, OR by specialty
• Internal Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2009; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.