Active NPI
Kerry A Peel
- Family Medicine Physician
- Boulder, CO
National Provider Identifier
1225165293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 37222
- Practice address
- 580 Mohawk Dr
Boulder, CO 80303-3712 - Phone
- (303) 338-4545
- NPI assigned
- Feb 27, 2007
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 37222 | CO | Primary |
Addresses
Primary practice location
580 Mohawk Dr
Boulder, CO 80303-3712
Mailing address
580 Mohawk Dr
Boulder, CO 80303-3712
Phone (303) 338-4545
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 010840 | Other | CO | KAISER COMMERCIAL NUMBER |
| 40754596 | Medicaid | CO |
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 |
|---|---|---|---|
| 37222 | CO | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1342396800000",
"number": "1225165293",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "580 MOHAWK DR",
"city": "BOULDER",
"state": "CO",
"postal_code": "803033712",
"telephone_number": "303-338-4545"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "580 MOHAWK DR",
"city": "BOULDER",
"state": "CO",
"postal_code": "803033712",
"telephone_number": "303-338-4545"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEEL",
"first_name": "KERRY",
"middle_name": "A",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-27",
"last_updated": "2012-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CO",
"license": "37222",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KAISER COMMERCIAL NUMBER",
"identifier": "010840",
"state": "CO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40754596",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boulder, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.