Active NPI
Karen Marie Peterson, M.D.
- Psychiatry Physician
- Fairfield, CA
National Provider Identifier
1366505307
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- G87435
- Practice address
- 101 Bodin Circle
David Grant Medical Center
Fairfield, CA 94535-1809 - Phone
- (707) 423-5174
- NPI assigned
- Dec 19, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | G87435 | CA | Primary |
Addresses
Primary practice location
101 Bodin Circle
David Grant Medical Center
Fairfield, CA 94535-1809
Mailing address
2530 Edwards Ave
El Cerrito, CA 94530-1471
Phone (707) 628-3192
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G87435 | CA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166486400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1349136000000",
"number": "1366505307",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2530 EDWARDS AVE",
"city": "EL CERRITO",
"state": "CA",
"postal_code": "945301471",
"telephone_number": "707-628-3192"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 BODIN CIRCLE",
"address_2": "DAVID GRANT MEDICAL CENTER",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945351809",
"telephone_number": "707-423-5174"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "KAREN",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-19",
"last_updated": "2012-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "G87435",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfield, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.