NPIMap

Individual provider Active NPI

Carl Roy Peterson III, M.D., M.S.

  • Radiation Oncology Physician
  • Boardman, OH
National Provider Identifier
1114151230
Registry record updated Dec 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
License
35.123850 Issued in OH
Practice address
8401 Market St
Boardman, OH 44512-6725
Phone
(330) 629-7500
Fax
(330) 629-7504
NPI assigned
May 4, 2009
Last updated
Dec 29, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X 35.123850 OH Primary
Radiation Oncology Physician 2085R0001X 35.091496 OH

Addresses

Primary practice location

8401 Market St
Boardman, OH 44512-6725

Mailing address

8401 Market St
Boardman, OH 44512-6725
Phone (330) 629-7500

Other identifiers 1

IdentifierTypeStateIssuer
0107099MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20140814001662 OH Practitioner - Radiation Oncology 2062639016 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Radiation Oncology
Education
Clvlnd Clinic Lerner College of Med of Case WSTN RSV University, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

8401 Market St
Boardman, OH 44512-6725
Phone (330) 729-2929

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35.091496OHMDCardiovascular Disease Physician
35.123850OHMDRadiation Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health Physicians Youngstown, LLC Current Accepting new patients
Mercy Health Physicians Youngstown Specialty Care LLC CurrentSince Jan 1, 2022 Accepting new patients
Triad Health Services, LLC CurrentSince Oct 1, 2015 Accepting new patients
Neo Urology Associates Inc CurrentSince Aug 20, 2014 Accepting new patients
Mercy Health Physicians Youngstown Specialty Care LLC CurrentSince Jan 1, 2022 Accepting new patients
Mercy Health Physicians Youngstown Specialty Care LLC Current Accepting new patients
Mercy Health Physicians Youngstown LLC CurrentSince Jul 28, 2014 Accepting new patients
Dermatology Associates of Youngstown Inc Past Accepting new patients
The Surgery Center at Southwoods, LLC Past Accepting new patients
Mercy Health Physicians Cincinnati LLC PastSince Jan 1, 2020 Accepting new patients

Locations

410 W 10th Ave
Columbus, OH 43210
Phone (614) 293-5905

100 Debartolo Pl
Ste 200
Youngstown, OH 44512
Phone (330) 965-7828

1044 Belmont Ave
Youngstown, OH 44504
Phone (330) 480-2182

6262 Mahoning Ave
Ste B
Youngstown, OH 44515
Phone (330) 758-9787

6262 Mahoning Ave
Ste C
Youngstown, OH 44515
Phone 3307299214225

7430 Southern Blvd
Youngstown, OH 44512
Phone (330) 729-9214

7629 Market St
Ste 250
Youngstown, OH 44512
Phone (330) 729-9480

8401 Market St
Youngstown, OH 44512
Phone (330) 729-2929

Interoperability endpoints

  • Direct secure messaging: cpeterson133690@direct.bsmhealth.org

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1241395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482969600000",
    "number": "1114151230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8401 MARKET ST",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445126725",
            "telephone_number": "330-629-7500",
            "fax_number": "330-629-7503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8401 MARKET ST",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445126725",
            "telephone_number": "330-629-7500",
            "fax_number": "330-629-7504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "CARL",
        "middle_name": "ROY",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D., M.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-05-04",
        "last_updated": "2016-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "OH",
            "license": "35.123850",
            "primary": true
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "OH",
            "license": "35.091496",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0107099",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boardman, OH

Sources for this page

Verify at the official NPI Registry.