Active NPI
Mary E. Peterson, M.D.
- Psychiatry Physician
- Spokane, WA
National Provider Identifier
1174572846
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 46080
- Practice address
- 105 W 8TH Ave Ste 6055
Spokane, WA 99204-2312 - Phone
- (509) 455-9090
- NPI assigned
- May 9, 2006
- Last updated
- Mar 13, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 46080 | WI | Primary |
Addresses
Primary practice location
105 W 8TH Ave Ste 6055
Spokane, WA 99204-2312
Mailing address
105 W 8TH Ave Ste 6055
Spokane, WA 99204-2312
Phone (509) 455-9090
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 46080 | WI | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Willamette Valley Clinics LLC | Psychiatry | Past | Accepting new patients |
Interoperability endpoints
- mary.peterson.p1@direct.scihp.nextgenshare.com
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147132800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1426204800000",
"number": "1174572846",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 W 8TH AVE STE 6055",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992042312",
"telephone_number": "509-455-9090"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 W 8TH AVE STE 6055",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992042312",
"telephone_number": "509-455-9090"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "MARY",
"middle_name": "E.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-09",
"last_updated": "2015-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "WI",
"license": "46080",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Spokane, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 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.