Frederick Peterson, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME32196 Issued in FL

Practice address

6100 Minton Rd NW
Ste104
Palm Bay, FL 32907-1975

Phone

(321) 724-1172

Fax

(321) 724-9024

NPI assigned

Dec 21, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 7

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

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

Practice roles

Interoperability endpoints

• Direct secure messaging: fpeterson71438@epicdirect.hf.org

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.

• Vitas Solutions Inc

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Miramar, FL
  • NPI 1861666497
  Medicare reassignment
• Omni Healthcare, Inc.

  • Specialist
  • Melbourne, FL
  • NPI 1134191323

  Family Medicine

  NPD (past)

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

{
    "created_epoch": "1135123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617062400000",
    "number": "1215913165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6100 MINTON RD NW",
            "address_2": "STE104",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329071975",
            "telephone_number": "321-724-1172",
            "fax_number": "321-724-9024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6100 MINTON RD NW",
            "address_2": "STE104",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329071975",
            "telephone_number": "321-724-1172",
            "fax_number": "321-724-9024"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4450 W Eau Gallie Blvd Ste 250",
            "address_purpose": "LOCATION",
            "city": "Melbourne",
            "state": "FL",
            "postal_code": "329347215",
            "country_code": "US",
            "telephone_number": "877-868-4827",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "FREDERICK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-21",
        "last_updated": "2021-03-30",
        "certification_date": "2021-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME32196",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080185086",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "038494100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5840654",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "2830929",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "200859",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "62193",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "2049145010",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "referral@vitas.direct.kno2fy.com",
            "affiliation": "Y",
            "affiliationName": "VITAS Solutions Inc",
            "address_1": "3720 Executive Way",
            "city": "Miramar",
            "state": "FL",
            "country_code": "US",
            "postal_code": "330253946",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lawrence Reginald Perdue, DC
• Ruby Perez Gonzalez
• Patricia Perez Hernandez
• Kristy Lee Perkins, BCBA
• Marissa Marie Peters
• Marie Petiote, APRN
• Briana Ariah Petty-Carter, COTA
• Pharmacy Ventures LLC
• Jouzelie Philippi-Exantus
• Esther Elizabeth Phillips-Dwyer, B.S., M. S., J.D.

• Family Medicine Physician in Palm Bay, FL
• Providers in Palm Bay, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2021; 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.