Active NPI
Megan Nicole Peterson, DO
- Pediatrics Physician
- Charleson, SC
National Provider Identifier
1205512266
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- LL89969
- Practice address
- 10 McClennan Banks Dr MSC 915
Charleson, SC 29425 - Phone
- (843) 243-7138
- NPI assigned
- Jun 26, 2023
- Last updated
- Jun 26, 2023
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | LL89969 | SC | Primary |
Addresses
Primary practice location
10 McClennan Banks Dr MSC 915
Charleson, SC 29425
Mailing address
10 McClennan Banks Dr MSC 915
Charleston, SC 29425
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240106000535 | SC | Order and Referring Only - Pediatric Medicine | 4688025364 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1687737600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687737600000",
"number": "1205512266",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 MCCLENNAN BANKS DR MSC 915",
"city": "CHARLESTON",
"state": "SC",
"postal_code": "29425"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 MCCLENNAN BANKS DR MSC 915",
"city": "CHARLESON",
"state": "SC",
"postal_code": "29425",
"telephone_number": "843-243-7138"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "MEGAN",
"middle_name": "NICOLE",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-06-26",
"last_updated": "2023-06-26",
"certification_date": "2023-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "SC",
"license": "LL89969",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2023; 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.