Justin Ross Peterson, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

154828 Issued in CA

Practice address

15301 Warren Shingle Rd
Attn: Ken Winn, Credential Coordinator
Beale AFB, CA 95903

Phone

(530) 634-4662

NPI assigned

Mar 1, 2014

Last updated

Sep 4, 2025By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1393632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756944000000",
    "number": "1174948012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15301 WARREN SHINGLE RD",
            "city": "BEALE AFB",
            "state": "CA",
            "postal_code": "959031905",
            "telephone_number": "530-634-4662",
            "fax_number": "530-634-4763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15301 WARREN SHINGLE RD",
            "address_2": "ATTN: KEN WINN, CREDENTIAL COORDINATOR",
            "city": "BEALE AFB",
            "state": "CA",
            "postal_code": "95903",
            "telephone_number": "530-634-4662"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 Bodin Cir",
            "address_purpose": "LOCATION",
            "city": "Travis AFB",
            "state": "CA",
            "postal_code": "945351809",
            "country_code": "US",
            "telephone_number": "707-423-7611",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JUSTIN",
        "middle_name": "ROSS",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-01",
        "last_updated": "2025-09-04",
        "certification_date": "2025-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101259916",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "154828",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maud Oliver-Kelley, RPH
• Michael Henry Osterhoudt, O.D.
• Lia Palmacci, DMD
• Wanda Louise Parham, O.D.
• James Perman, DDS
• Katelyn Mae Prasad
• Tadd Olin Knox Ragsdale, IDMT
• Brian M Ritchie, IDMT
• Danyel K. Robinson, LCSW
• Michael Rodriguez

• Internal Medicine Physician in Beale AFB, CA
• Providers in Beale AFB, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.