Active NPI
Polly Peterson, PHD
- Clinical Psychologist
- Butte, MT
National Provider Identifier
1316324700
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY-PSY-LIC-337
- Practice address
- 125 W Granite St Ste 212
Butte, MT 59701-9215 - Phone
- (406) 560-3097
- NPI assigned
- May 5, 2015
- Last updated
- Apr 1, 2016
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY-PSY-LIC-337 | MT | Primary |
Addresses
Primary practice location
125 W Granite St Ste 212
Butte, MT 59701-9215
Mailing address
PO Box 448
Anaconda, MT 59711-0448
Phone (406) 560-3097
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200321000590 | MT | Practitioner - Clinical Psychologist | 7618303744 | Practice locations: Butte, MT |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1986
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
125 W Granite St
Suite 212
Butte, MT 59701-9215
Phone (406) 560-3097
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY-PSY-LIC-337 | MT | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1430784000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1459468800000",
"number": "1316324700",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 448",
"city": "ANACONDA",
"state": "MT",
"postal_code": "597110448",
"telephone_number": "406-560-3097"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "125 W GRANITE ST STE 212",
"city": "BUTTE",
"state": "MT",
"postal_code": "597019215",
"telephone_number": "406-560-3097"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "POLLY",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-05-05",
"last_updated": "2016-04-01",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MT",
"license": "PSY-PSY-LIC-337",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Butte, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.