NPIMap

Individual provider Active NPI

Melissa Fay Peters, ARNP

  • Nurse Practitioner
  • Live Oak, FL
National Provider Identifier
1114439510
Registry record updated Jul 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
9291513 Issued in FL
Practice address
1304 Ohio Ave S
Live Oak, FL 32064-4156
Phone
(386) 364-0776
NPI assigned
Oct 26, 2017
Last updated
Jul 13, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 9291513 FL Primary

Addresses

Primary practice location

1304 Ohio Ave S
Live Oak, FL 32064-4156

Mailing address

1304 Ohio Ave S
Live Oak, FL 32064-4156
Phone (386) 364-0776

Other practice location 1

5085 West US Highway 90
Lake City, FL 32055
Phone (386) 752-0090

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20171120001186 FL Practitioner - Nurse Practitioner 1557628963 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ankem Ravindra MD PAGroup PAC ID 1951446640, 8 clinicians

Practice addresses (Care Compare)

1211 SW Bascom Norris Dr
Lake City, FL 32025-4916
Phone (386) 752-3400

1304 Ohio Ave S
Live Oak, FL 32064-4156
Phone (386) 364-0767

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
9291513FLMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Live Oak Family Practice, LLC CurrentSince May 20, 2021 Accepting new patients
Giebeig Family Medicine PA CurrentSince Oct 26, 2017 Accepting new patients
Ankem Ravindra MD PA CurrentSince Apr 1, 2025 Accepting new patients
Simedhealth LLC PastSince Oct 26, 2017 Accepting new patients

Locations

1211 SW Bascom Norris Dr
Lake City, FL 32025
Phone (386) 326-3633

5085 W US Highway 90
Lake City, FL 32055
Phone (386) 752-0090

1304 Ohio Ave S
Live Oak, FL 32064
Phone (386) 364-0767

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/24230/brand/1/csg/1/fhir/r4
  • FHIR API: https://api.platform.athenahealth.com/3782/brand/1/csg/1/fhir/r4
  • Direct secure messaging: melissa.peters.1@24230.direct.athenahealth.com

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, 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": "1508976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626134400000",
    "number": "1114439510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1304 OHIO AVE S",
            "city": "LIVE OAK",
            "state": "FL",
            "postal_code": "320644156",
            "telephone_number": "386-364-0776",
            "fax_number": "386-364-1211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1304 OHIO AVE S",
            "city": "LIVE OAK",
            "state": "FL",
            "postal_code": "320644156",
            "telephone_number": "386-364-0776"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5085 West US Highway 90",
            "address_purpose": "LOCATION",
            "city": "Lake City",
            "state": "FL",
            "postal_code": "32055",
            "country_code": "US",
            "telephone_number": "386-752-0090",
            "fax_number": "386-719-9494",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERS",
        "first_name": "MELISSA",
        "middle_name": "FAY",
        "name_prefix": "Mrs.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-26",
        "last_updated": "2021-07-13",
        "certification_date": "2021-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "9291513",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Live Oak, FL

Sources for this page

Verify at the official NPI Registry.