Active NPI
Donald Walter Peters, MD
- Psychiatry Physician
- Winston Salem, NC
National Provider Identifier
1194709162
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 28608
- Practice address
- 791 Jonestown Rd
Winston Salem, NC 27103-1252 - Phone
- (336) 716-3693
- NPI assigned
- Dec 2, 2005
- Sex
- Male
- 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 | 28608 | NC | Primary |
Addresses
Primary practice location
791 Jonestown Rd
Winston Salem, NC 27103-1252
Mailing address
PO Box 602658
Charlotte, NC 28260-2658
Phone (336) 716-2011
Other identifiers 9
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 203711000 | Medicaid | WV | |
| 29247 | Other | MEDCOST | |
| 8967165 | Medicaid | NC | |
| 67165 | Other | BCBS | |
| 260050043 | Other | RR MEDICARE | |
| 5457218 | Other | AETNA | |
| Q28608 | Medicaid | SC | |
| 4757 | Other | PARTNERS | |
| 7140291 | Medicaid | VA |
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 |
|---|---|---|---|
| 28608 | NC | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133481600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1427932800000",
"number": "1194709162",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 602658",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282602658",
"telephone_number": "336-716-2011"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "791 JONESTOWN RD",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271031252",
"telephone_number": "336-716-3693"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERS",
"first_name": "DONALD",
"middle_name": "WALTER",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-02",
"last_updated": "2015-04-02",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NC",
"license": "28608",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "203711000",
"state": "WV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDCOST",
"identifier": "29247",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8967165",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "67165",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "260050043",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "5457218",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "Q28608",
"state": "SC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PARTNERS",
"identifier": "4757",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7140291",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Winston Salem, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 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.