Individual provider Active NPI

Darryl W. Peterson, MD

  • Orthopaedic Hand Surgery Physician
  • College Station, TX
National Provider Identifier
1174579874
Registry record updated Mar 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Hand Surgery PhysicianTaxonomy code 207XS0106X
License
K3391 Issued in TX
Practice address
2803 Earl Rudder Fwy S Ste 202
College Station, TX 77845-6099
Phone
(979) 731-8888
Fax
(979) 731-8935
NPI assigned
May 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Hand Surgery Physician 207XS0106X K3391 TX Primary
Orthopaedic Surgery Physician 207X00000X K3391 TX
Orthopaedic Surgery Physician 207X00000X 12182R LA

Addresses

Primary practice location

2803 Earl Rudder Fwy S Ste 202
College Station, TX 77845-6099

Mailing address

2800 S Texas Ave Ste 202
Bryan, TX 77802-5361
Phone (979) 774-2061

Other practice location 1

2803 Earl Rudder Fwy S Ste 103
College Station, TX 77845-6099
Phone (979) 731-8888

Other identifiers 2

IdentifierTypeStateIssuer
1543365MedicaidLA
370416501MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170516001483 TX Practitioner - Hand SurgeryPractitioner - Orthopedic Surgery 9537171343 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hand SurgeryAlso: Orthopedic Surgery
Education
Hahnemann University College of Medicine, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Joseph Regional Health CenterGroup PAC ID 5294727921, 141 clinicians

Practice addresses (Care Compare)

2803 Earl Rudder Fwy S
Suite 202
College Station, TX 77845-6099
Phone (979) 731-8888

Hospital & facility affiliations

  • CHI St Joseph Health Regional Hospital Hospital, Bryan, TX, CCN 450011
  • Burleson St Joseph Health Center Hospital, Caldwell, TX, CCN 451305

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper limb (arm) arthroscopy (minimally invasive joint repair)1-10
Removal of tissue12
Removal of nail tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
12182RLAMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Joseph Regional Health Center Family Medicine CurrentSince May 31, 2017 Accepting new patients
St Joseph Regional Health Center CurrentSince May 31, 2017 Accepting new patients
College Station Hospital LP Past Accepting new patients

Locations

2800 S Texas Ave
Ste 202
Bryan, TX 77802
Phone (979) 774-2060

2801 Franciscan Dr
Bryan, TX 77802
Phone (409) 776-3777

2803 Earl Rudder Fwy S
Ste 103
College Station, TX 77845
Phone (979) 731-8888

2803 Earl Rudder Fwy S
Ste 202
College Station, TX 77845
Phone (979) 731-8888

Interoperability endpoints

  • Direct secure messaging: darryl.peterson@sjrhc.eclinicaldirectplus.com
  • Direct secure messaging: dpeterson457963@direct.stlukeshealth.org

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 4

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": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742342400000",
    "number": "1174579874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 S TEXAS AVE STE 202",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778025361",
            "telephone_number": "979-774-2061",
            "fax_number": "979-776-5914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2803 EARL RUDDER FWY S STE 202",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778456099",
            "telephone_number": "979-731-8888",
            "fax_number": "979-731-8935"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2803 Earl Rudder Fwy S Ste 103",
            "address_purpose": "LOCATION",
            "city": "College Station",
            "state": "TX",
            "postal_code": "778456099",
            "country_code": "US",
            "telephone_number": "979-731-8888",
            "fax_number": "979-731-8935",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "DARRYL",
        "middle_name": "W.",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-25",
        "last_updated": "2025-03-19",
        "certification_date": "2025-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XS0106X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Hand Surgery",
            "state": "TX",
            "license": "K3391",
            "primary": true
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "TX",
            "license": "K3391",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "LA",
            "license": "12182R",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1543365",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "370416501",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in College Station, TX

Sources for this page

Verify at the official NPI Registry.