Active NPI
Peter Harris
- Pediatric Adolescent Medicine Physician
- Grass Valley, CA
National Provider Identifier
1134563109
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Adolescent Medicine Physician
- License
- A136735
- Practice address
- 140 Litton Dr Ste 100
Grass Valley, CA 95945-5078 - Phone
- (530) 272-9780
- Fax
- (530) 272-0156
- NPI assigned
- Apr 22, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Pediatric Adolescent Medicine Physician | 2080A0000X | A136735 | CA | Primary |
Addresses
Primary practice location
140 Litton Dr Ste 100
Grass Valley, CA 95945-5078
Mailing address
PO Box 459001
Grass Valley, CA 95945-9101
Phone (530) 272-9780
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A136735 | CA | MD | Pediatric Adolescent Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Western Sierra Medical Clinic, Inc. | Past | Accepting new patients | |
| Sierra Nevada Memorial-Miners Hospital | Past | Accepting new patients |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Organizations & group practices 2
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.
-
- General Acute Care Hospital
- Grass Valley, CA
- NPI 1659361392
-
- Federally Qualified Health Center (FQHC)
- Grass Valley, CA
- NPI 1063496396
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1366588800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1512432000000",
"number": "1134563109",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 459001",
"city": "GRASS VALLEY",
"state": "CA",
"postal_code": "959459101",
"telephone_number": "530-272-9780"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "140 LITTON DR STE 100",
"city": "GRASS VALLEY",
"state": "CA",
"postal_code": "959455078",
"telephone_number": "530-272-9780",
"fax_number": "530-272-0156"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARRIS",
"first_name": "PETER",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-04-22",
"last_updated": "2017-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "2080A0000X",
"taxonomy_group": "",
"desc": "Pediatrics, Adolescent Medicine",
"state": "CA",
"license": "A136735",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grass Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.