Peter Boettger, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

100862 Issued in NC

Practice address

600 Moye Blvd
Leo Jenkins Cancer Center
Greenville, NC 27858

Phone

(252) 744-2383

Fax

(252) 744-3565

NPI assigned

Dec 19, 2005

Last updated

Mar 4, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Newco Cancer Services, LLC

  • Radiation Oncology Physician
  • Greenville, NC
  • NPI 1528375052
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1134950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425427200000",
    "number": "1174509541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751069",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751069",
            "telephone_number": "252-744-3253",
            "fax_number": "252-744-3194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 MOYE BLVD",
            "address_2": "LEO JENKINS CANCER CENTER",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "27858",
            "telephone_number": "252-744-2383",
            "fax_number": "252-744-3565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOETTGER",
        "first_name": "PETER",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-19",
        "last_updated": "2015-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "100862",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "970005706",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Parker Teague Blum
• Amy L Blumenthal, M.D.
• BN Healthcare, LLC (Tar River Manor)
• Jo Elizabeth Bocock
• Bodies N Balance
• Boeyer Enterprise , LLC
• William M Bogey Jr., M.D.
• Van Boghossian, MD
• Andrew Michael Bolick, CRNA
• Camryn Jaden Bolick

• Medical Physician Assistant in Greenville, NC
• Providers in Greenville, NC by specialty
• Medical Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.