Timothy A Peters, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01043381 Issued in IN

Practice address

1919 Lake Ave
Suite 104
Plymouth, IN 46563-7830

Phone

(574) 941-2929

Fax

(574) 941-3008

NPI assigned

Jun 29, 2006

Last updated

May 8, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Saint Joseph Regional Medical Center, Inc.

  dba Saint Joseph Medical Group

  • Pulmonary Disease Physician
  • Plymouth, IN
  • NPI 1225082878

  Internal Medicine

  NPD (past)

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431043200000",
    "number": "1285662171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6309",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466606309",
            "telephone_number": "574-335-8700",
            "fax_number": "574-335-0760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1919 LAKE AVE",
            "address_2": "SUITE 104",
            "city": "PLYMOUTH",
            "state": "IN",
            "postal_code": "465637830",
            "telephone_number": "574-941-2929",
            "fax_number": "574-941-3008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERS",
        "first_name": "TIMOTHY",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-29",
        "last_updated": "2015-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01043381",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01043381",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000000216162",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000000659776",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100380540",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100380540A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amy Patterson, LCSW
• Katherine Patton
• Brittany Pedavoli
• Adam Eric Perlmutter, DO
• Kelsey Perry
• Brian L Piazza, M.D.
• Aubree Pittman
• Louis D. Plumlee, D.D.S.
• Plymouth 20/20 Dental, LLC
• Plymouth Community School Corporation

• Family Medicine Physician in Plymouth, IN
• Providers in Plymouth, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 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.