NPIMap

Organization Active NPI

Douglas E. Peterson, LLC

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Danvers, MA
National Provider Identifier
1336491612
Registry record updated Dec 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
License
153208 Issued in MA
Legal business name
DOUGLAS E. PETERSON, LLC
Practice address
4 State Rd
Danvers, MA 01923-2567
Phone
(978) 774-3400
Fax
(978) 774-5883
NPI assigned
Oct 10, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2021

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

Authorized official

Name
Dr. Douglas Edward Peterson, D.O.NPI 1477535896
Title
Orthopedic Surgeon
Phone
(978) 774-3400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207XX0005X 153208 MA Primary

Addresses

Primary practice location

4 State Rd
Danvers, MA 01923-2567

Mailing address

4 State Rd
Danvers, MA 01923-2567
Phone (978) 774-3400

Other practice location 1

100 Highland Ave Ste 101
Salem, MA 01970-2702
Phone (978) 745-0820

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121106000655 MA Part B Supplier - Clinic/Group Practice 3678724325 Receives reassigned benefits from 4 practitioners
Practice locations: Danvers, MA; Salem, MA

National Provider Directory

National Provider Directory
Tax ID family
Douglas E Peterson2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1349827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639440000000",
    "number": "1336491612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 STATE RD",
            "city": "DANVERS",
            "state": "MA",
            "postal_code": "019232567",
            "telephone_number": "978-774-3400",
            "fax_number": "978-774-5883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 STATE RD",
            "city": "DANVERS",
            "state": "MA",
            "postal_code": "019232567",
            "telephone_number": "978-774-3400",
            "fax_number": "978-774-5883"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Highland Ave Ste 101",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "MA",
            "postal_code": "019702702",
            "country_code": "US",
            "telephone_number": "978-745-0820",
            "fax_number": "978-774-5883",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DOUGLAS E. PETERSON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-10",
        "last_updated": "2021-12-14",
        "certification_date": "2021-12-14",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "ORTHOPEDIC SURGEON",
        "authorized_official_telephone_number": "978-774-3400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "MA",
            "license": "153208",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Danvers, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.