Gregory Wayne Petersburg, D.O.

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

License

3714 Issued in AZ

Practice address

10371 N Oracle Rd
Suite 205
Oro Valley, AZ 85737-9392

Phone

(520) 229-1900

Fax

(520) 742-2900

NPI assigned

Mar 5, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Nov 3, 2014 through Nov 3, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Taos Health Systems, Inc., Holy Cross Hospital

  • Critical Access Hospital
  • Taos, NM
  • NPI 1902338049
  NPD (past)

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

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1225167281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10371 N ORACLE RD",
            "address_2": "SUITE 205",
            "city": "ORO VALLEY",
            "state": "AZ",
            "postal_code": "857379392",
            "telephone_number": "520-229-1900",
            "fax_number": "520-742-2900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10371 N ORACLE RD",
            "address_2": "SUITE 205",
            "city": "ORO VALLEY",
            "state": "AZ",
            "postal_code": "857379392",
            "telephone_number": "520-229-1900",
            "fax_number": "520-742-2900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSBURG",
        "first_name": "GREGORY",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "AZ",
            "license": "3714",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AZ MEDICAL LICENSE",
            "identifier": "3714",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Taylor Allen Pechauer, DPT
• Pediatric Cardiac Care of Arizona
• Kirsten Pennartz, PT
• Eric Scott Perry, D.O.
• George Lawrence Perry, D.D.S.
• Jacob Reis Peterson
• Samuel Peterson, DMD
• Seth Peterson, PT, DPT
• Franklyn R Pfeil, PT, DPT
• Hoai Duc Pham, M.D.

• Adult Medicine Physician in Oro Valley, AZ
• Providers in Oro Valley, AZ by specialty
• Adult Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.