Active NPI
McKim C Peterson, M. D.
- Family Medicine Physician
- Rockport, ME
National Provider Identifier
1265549869
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 013075
- Practice address
- 195 Union St
Midcoast Medicine, PA
Rockport, ME 04856-6107 - Phone
- (207) 236-2169
- Fax
- (207) 230-0413
- NPI assigned
- Aug 23, 2006
- 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 | 013075 | ME | Primary |
Addresses
Primary practice location
195 Union St
Midcoast Medicine, PA
Rockport, ME 04856-6107
Mailing address
PO Box 1079
Midcoast Medicine, PA
Rockport, ME 04856-1079
Phone (207) 236-2169
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 130430000 | Medicaid | ME |
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 |
|---|---|---|---|
| 013075 | ME | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1300924800000",
"number": "1265549869",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1079",
"address_2": "MIDCOAST MEDICINE, PA",
"city": "ROCKPORT",
"state": "ME",
"postal_code": "048561079",
"telephone_number": "207-236-2169",
"fax_number": "207-230-0413"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "195 UNION ST",
"address_2": "MIDCOAST MEDICINE, PA",
"city": "ROCKPORT",
"state": "ME",
"postal_code": "048566107",
"telephone_number": "207-236-2169",
"fax_number": "207-230-0413"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "MCKIM",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "M. D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-23",
"last_updated": "2011-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "ME",
"license": "013075",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "130430000",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rockport, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.