Active NPI
Peter Joseph Mecham
- Endodontics
- Gainesville, FL
National Provider Identifier
1306133830
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 2228
- Practice address
- 1600 SW Archer Rd
Gainesville, FL 32610-0407 - Phone
- (352) 273-5950
- Fax
- (352) 846-3818
- NPI assigned
- Jul 5, 2011
- 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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 2228 | ND | Primary |
Addresses
Primary practice location
1600 SW Archer Rd
Gainesville, FL 32610-0407
Mailing address
2812 17TH Ave S
Ste a
Grand Forks, ND 58201-4048
Phone (701) 775-3101
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ND
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160323002423 | ND | Order and Referring Only - Other (Physician) | 5395042006 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2228 | ND | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1309824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1457481600000",
"number": "1306133830",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2812 17TH AVE S",
"address_2": "STE A",
"city": "GRAND FORKS",
"state": "ND",
"postal_code": "582014048",
"telephone_number": "701-775-3101"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 SW ARCHER RD",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326100407",
"telephone_number": "352-273-5950",
"fax_number": "352-846-3818"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MECHAM",
"first_name": "PETER",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-07-05",
"last_updated": "2016-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "ND",
"license": "2228",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gainesville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2016; 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.