NPIMap

Individual provider Active NPI

A Perrin Peterson, ACSW, LCSW

  • Clinical Social Worker
  • Punta Gorda, FL
National Provider Identifier
1285652370
Registry record updated Jan 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SW7101 Issued in FL
Practice address
27192 San Marino Dr
Punta Gorda, FL 33983-3127
Phone
(941) 626-8363
NPI assigned
Jul 17, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 6, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LC9524 ME
Clinical Social Worker 1041C0700X SW7101 FL Primary
Clinical Social Worker 1041C0700X CSW002292 GA

Addresses

Primary practice location

27192 San Marino Dr
Punta Gorda, FL 33983-3127

Mailing address

27192 San Marino Dr
Punta Gorda, FL 33983-3127
Phone (941) 626-8363

Other identifiers 2

IdentifierTypeStateIssuer
Z034MOtherFLBCBS
412090099MedicaidME

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

State licenses

LicenseStateTypeSpecialty
SW7101FLMDClinical Social Worker
CSW002292GAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Life by Design, PA Clinical PastSince Feb 1, 2004 Accepting new patients
Carlos G. Otis Health Care Center Inc. Past Accepting new patients
Life by Design Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420502400000",
    "number": "1285652370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27192 SAN MARINO DR",
            "city": "PUNTA GORDA",
            "state": "FL",
            "postal_code": "339833127",
            "telephone_number": "941-626-8363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27192 SAN MARINO DR",
            "city": "PUNTA GORDA",
            "state": "FL",
            "postal_code": "339833127",
            "telephone_number": "941-626-8363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "A",
        "middle_name": "PERRIN",
        "name_prefix": "Mr.",
        "credential": "ACSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2015-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC9524",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW7101",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW002292",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "Z034M",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "412090099",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Punta Gorda, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.