Individual provider Active NPI

Peter R Purrington, MD

  • Hospitalist Physician
  • Coeur D Alene, ID
National Provider Identifier
1114020666
Registry record updated Aug 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
M12905 Issued in ID
Practice address
1090 W Park PL
Coeur D Alene, ID 83814-2785
Phone
(208) 215-2005
Fax
(844) 807-3782
NPI assigned
Sep 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2021

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 12905 ID
Hospitalist Physician 208M00000X M12905 ID Primary

Addresses

Primary practice location

1090 W Park PL
Coeur D Alene, ID 83814-2785

Mailing address

PO Box 1387
Hayden, ID 83835-1387
Phone (208) 415-0299

Other identifiers 1

IdentifierTypeStateIssuer
1114020666MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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

Enrollment IDStateProvider typePAC IDDetails
I20080902000097 TN Practitioner - Family Practice 9537235312 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
George Washington University School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southeastern Physician Services PCGroup PAC ID 0042307852, 591 clinicians

Practice addresses (Care Compare)

651 Dunlop LN
Clarksville, TN 37040-5015
Phone (931) 502-1370

Hospital & facility affiliations

  • Vanderbilt Clarksville Hospital Hospital, Clarksville, TN, CCN 440035

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
41728TNMDAmbulatory Care Pharmacist
12905IDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southeastern Physician Services PC Hospitalist CurrentSince Aug 1, 2023 Accepting new patients
App of Tennessee HM, PLLC Hospitalist CurrentSince Nov 1, 2021 Accepting new patients
Clarksville Physician Services, LLC Past Accepting new patients
Tennessee Heart and Lung Institute PLC Past Accepting new patients

Locations

5121 Maryland Way
Ste 300
Brentwood, TN 37027
Phone (615) 436-6556

651 Dunlop Ln
Clarksville, TN 37040
Phone (931) 502-1000

1607 S Locust Ave
Lawrenceburg, TN 38464
Phone (731) 287-2244

2835 Highway 231 N
Shelbyville, TN 37160
Phone (931) 685-5433

1201 Bishop St
Union City, TN 38261
Phone (423) 698-6061

Organizations & group practices 4

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 1

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": "1157587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629849600000",
    "number": "1114020666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1387",
            "city": "HAYDEN",
            "state": "ID",
            "postal_code": "838351387",
            "telephone_number": "208-415-0299",
            "fax_number": "208-625-2070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1090 W PARK PL",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142785",
            "telephone_number": "208-215-2005",
            "fax_number": "844-807-3782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PURRINGTON",
        "first_name": "PETER",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-07",
        "last_updated": "2021-08-25",
        "certification_date": "2021-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "12905",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "ID",
            "license": "M12905",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1114020666",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Coeur D Alene, ID

Sources for this page

Verify at the official NPI Registry.