Individual provider Active NPI

John C Peterson, MD

  • Anesthesiology Physician
  • Omaha, NE
National Provider Identifier
1144312992
Registry record updated Nov 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
18176 Issued in NE
Practice address
7822 Davenport St
Omaha, NE 68114-3629
Phone
(402) 391-4855
Fax
(402) 391-6818
NPI assigned
Sep 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 18176 NE Primary

Addresses

Primary practice location

7822 Davenport St
Omaha, NE 68114-3629

Mailing address

7822 Davenport St
Omaha, NE 68114-3629
Phone (402) 391-4855

Other identifiers 2

IdentifierTypeStateIssuer
089122OtherMEDICARE
050024928OtherRR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of Nebraska College of Medicine, 1986
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

15209 Lloyd Cir
Omaha, NE 68144-5144

Hospital & facility affiliations

  • Nebraska Orthopaedic Hospital Hospital, Omaha, NE, CCN 280129

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
18176NEMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Orthoanesthesia, PC Anesthesiology CurrentSince Dec 1, 2019 Accepting new patients
Diagnostic & Int Med Assoc PC Past Accepting new patients
Hinners Geriatric Medicine, LLC PastSince Feb 1, 2022 Accepting new patients

Locations

2808 S 143rd Plz
Omaha, NE 68144
Phone (321) 223-0225

Organizations & group practices 3

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": "1159488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572566400000",
    "number": "1144312992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7822 DAVENPORT ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681143629",
            "telephone_number": "402-391-4855",
            "fax_number": "402-391-6818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7822 DAVENPORT ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681143629",
            "telephone_number": "402-391-4855",
            "fax_number": "402-391-6818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JOHN",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-29",
        "last_updated": "2019-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NE",
            "license": "18176",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "089122",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "050024928",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.