NPIMap

Individual provider Active NPI

Andrew J. Peterson, D.O.

  • Internal Medicine Physician
  • Biloxi, MS
National Provider Identifier
1306826854
Registry record updated Nov 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
20037 Issued in MS
Practice address
147 Reynoir Street
Suite 101
Biloxi, MS 39530
Phone
(228) 374-2051
Fax
(228) 374-5741
NPI assigned
Jan 20, 2006
Last updated
Nov 30, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 0102201779 VA
Internal Medicine Physician 207R00000X 20037 MS Primary

Addresses

Primary practice location

147 Reynoir Street
Suite 101
Biloxi, MS 39530

Mailing address

147 Reynoir Street
Suite 101
Biloxi, MS 39530
Phone (228) 374-2051

Other identifiers 1

IdentifierTypeStateIssuer
01977252MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090813000759 MS Practitioner - Internal Medicine 1456405208 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
West Virginia School of Osteopathic Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memorial Hospital at GulfportGroup PAC ID 2466524012, 473 clinicians
Biloxi Internal Medicine Clinic PAGroup PAC ID 9638249352, 4 clinicians

Practice addresses (Care Compare)

1104 Broad Ave
Gulfport, MS 39501-2414
Phone (228) 822-6811

147 Reynoir St
Suite 101
Biloxi, MS 39530-4119
Phone (228) 374-2051

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
20037MSMDInternal Medicine Physician
0102201779VAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Hospital at Gulfport CurrentSince Dec 16, 2024 Accepting new patients
Memorial Hospital at Gulfport Current Accepting new patients
Biloxi Internal Medicine Clinic PA Internal Medicine CurrentSince Oct 24, 2011 Accepting new patients
Memorial Hospital at Gulfport CurrentSince Dec 16, 2024 Accepting new patients

Locations

147 Reynoir St
Ste 101
Biloxi, MS 39530
Phone (228) 374-2051

150 Reynoir St
Biloxi, MS 39530
Phone (228) 284-2389

1104 Broad Ave
Gulfport, MS 39501
Phone (228) 343-4057

1340 Broad Ave
Ste 440
Gulfport, MS 39501
Phone (228) 867-4856

Organizations & group practices 4

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.

Hospital & facility affiliations 66

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 66

NPI Registry JSON

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

{
    "created_epoch": "1137715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1322611200000",
    "number": "1306826854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "147 REYNOIR STREET",
            "address_2": "SUITE 101",
            "city": "BILOXI",
            "state": "MS",
            "postal_code": "39530",
            "telephone_number": "228-374-2051",
            "fax_number": "228-374-5741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "147 REYNOIR STREET",
            "address_2": "SUITE 101",
            "city": "BILOXI",
            "state": "MS",
            "postal_code": "39530",
            "telephone_number": "228-374-2051",
            "fax_number": "228-374-5741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "ANDREW",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-20",
        "last_updated": "2011-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0102201779",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": "20037",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01977252",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Biloxi, MS

Sources for this page

Verify at the official NPI Registry.