Peter Vernon Goetchius, PHYSICIAN ASSISTANT

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

000219-0 Issued in NY

Practice address

11050 Mount Belvedere Blvd
USA Meddac Attn: Credentials
Fort Drum, NY 13602-5438

Phone

(315) 772-4025

Fax

(315) 772-9498

NPI assigned

Dec 20, 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1135036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211241600000",
    "number": "1285610451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11050 MOUNT BELVEDERE BLVD",
            "address_2": "USA MEDDAC ATTN: CREDENTIALS",
            "city": "FORT DRUM",
            "state": "NY",
            "postal_code": "136025438",
            "telephone_number": "315-772-4025",
            "fax_number": "315-772-9498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11050 MOUNT BELVEDERE BLVD",
            "address_2": "USA MEDDAC ATTN: CREDENTIALS",
            "city": "FORT DRUM",
            "state": "NY",
            "postal_code": "136025438",
            "telephone_number": "315-772-4025",
            "fax_number": "315-772-9498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOETCHIUS",
        "first_name": "PETER",
        "middle_name": "VERNON",
        "name_prefix": "Mr.",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-20",
        "last_updated": "2008-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "000219-0",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adam Stone Gardner, M.D.
• Annamarie E Gerick, DPT
• Madison German, LCSW
• Dakota M Gillmore, PHD
• Lisa Anne Goens, LPN
• Alberto Gonzalez, LCSW
• Shelly J Gonzalez, LCSW
• Gwen Katherine Gostomski, DMD
• Jessica Lynne Gourley, RN
• Gregory L Grau, AU.D.

• Medical Physician Assistant in Fort Drum, NY
• Providers in Fort Drum, NY by specialty
• Medical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2008; 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.