NPIMap

Individual provider Active NPI

Russell D Peterson, D.O.

  • Family Medicine Physician
  • Roanoke, AL
National Provider Identifier
1144322504
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DO436 Issued in AL
Practice address
965 US Hwy 431
Roanoke, AL 36274
Phone
(334) 863-2141
Fax
(334) 863-8733
NPI assigned
Sep 5, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X DO436 AL Primary

Addresses

Primary practice location

965 US Hwy 431
Roanoke, AL 36274

Mailing address

PO Box 625
Roanoke, AL 36274-0625
Phone (334) 863-2141

Other identifiers 2

IdentifierTypeStateIssuer
51091244OtherALBCBS OF ALABAMA
000091244MedicaidAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL, FL2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20100809000361 AL Practitioner - Family Practice 1153348651 Reassigns benefits to 1 organization
I20250304001820 FL Practitioner - Family Practice 1153348651 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Osteopathic Medicine, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Howard T Tee MD PLLCGroup PAC ID 9234490426, 2 clinicians
Tanner Primary Care of Roanoke IncGroup PAC ID 1153663091, 5 clinicians

Practice addresses (Care Compare)

960 37TH PL
Suite 105
Vero Beach, FL 32960-6586
Phone 772299190115

965 Hwy 431
Roanoke, AL 36274-7329
Phone (334) 863-2141

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of tissue1-10
Removal of skin lesions1-10
Removal of nail tissue1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DO436ALMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Howard T Tee MD PLLC CurrentSince Feb 1, 2025 Accepting new patients
Tanner Primary Care of Roanoke Inc Family Medicine CurrentSince May 1, 2019 Accepting new patients
Randolph Medical Associates Past Accepting new patients
Phoenix Healthcare LLC Past Accepting new patients
Medical Associates of East Al, PC Past Accepting new patients
Roanoke Healthcare Center LLC Past Accepting new patients
Randolph Management Company, Inc. Past Accepting new patients
Foot and Ankle Center of West Georgia PC PastSince Apr 15, 2010 Accepting new patients

Locations

965 Highway 431
Roanoke, AL 36274
Phone (334) 863-2142

960 37th Pl
Ste 105
Vero Beach, FL 32960
Phone (321) 361-5564

706 Dixie St
Ste 220
Carrollton, GA 30117
Phone (770) 812-8825

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/HFECBD
  • FHIR API: https://fhir4.healow.com/fhir/r4/HFECBD/Endpoint/HFECBD

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Compassus - GadsdenSouthside, AL, CCN 011579 Hospice Contracted Managing Employee Oct 1, 2016

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 9

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 8

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": "1157414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1144322504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 625",
            "city": "ROANOKE",
            "state": "AL",
            "postal_code": "362740625",
            "telephone_number": "334-863-2141",
            "fax_number": "334-863-8733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "965 US HWY 431",
            "city": "ROANOKE",
            "state": "AL",
            "postal_code": "36274",
            "telephone_number": "334-863-2141",
            "fax_number": "334-863-8733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "RUSSELL",
        "middle_name": "D",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "DO436",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF ALABAMA",
            "identifier": "51091244",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000091244",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, AL

Sources for this page

Verify at the official NPI Registry.