Peter Todd Mathison, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

1933 Issued in ND

Practice address

1351 Page Drive South
Suite 102
Fargo, ND 58103-3536

Phone

(701) 478-4500

Fax

(701) 478-4501

NPI assigned

Oct 4, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in ND

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104912609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1351 PAGE DRIVE SOUTH",
            "address_2": "SUITE 102",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581033536",
            "telephone_number": "701-478-4500",
            "fax_number": "701-478-4501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1351 PAGE DRIVE SOUTH",
            "address_2": "SUITE 102",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581033536",
            "telephone_number": "701-478-4500",
            "fax_number": "701-478-4501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHISON",
        "first_name": "PETER",
        "middle_name": "TODD",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ND",
            "license": "1933",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DSC OF ND",
            "identifier": "901933",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL OF MN",
            "identifier": "450484245-00001",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susanne M Mathias, RPH
• Kurt J Mathiason, CRNA
• Brian Cole Mathison, DDS
• Mariah Mathison
• Miranda Mathison
• Susan M Mathison, MD
• Amanda R Mattern, B.S.
• Travis J Mattern, CRNA
• Donald J Matthees, MD
• Alexandra Matthews, L.AC

• All providers in Fargo, ND
• Dentist in North Dakota

• 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.
• 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.