Individual provider Active NPI

Robert Peters IV, M.D.

  • Family Medicine Physician
  • Tarboro, NC
National Provider Identifier
1386614162
Registry record updated Jan 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
25519 Issued in NC
Practice address
101 Clinic Dr
Tarboro, NC 27886-1935
Phone
(252) 823-2105
NPI assigned
Jan 25, 2006
Last updated
Jan 13, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 25519 NC Primary

Addresses

Primary practice location

101 Clinic Dr
Tarboro, NC 27886-1935

Mailing address

101 Clinic Dr
Tarboro, NC 27886-1935
Phone (252) 823-2105

Other identifiers 5

IdentifierTypeStateIssuer
8967162MedicaidNC
29252OtherNCMEDCOST
0152269OtherNCUNITED HEALTHCARE
67162OtherNCBCBS
080043282OtherNCRAILROAD MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100105000206 NC Practitioner - Family Practice 8820178296 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of North Carolina at Chapel Hill School of Medicine, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vidant Medical Group LLCGroup PAC ID 0345343893, 986 clinicians

Practice addresses (Care Compare)

101 Clinic Dr
Tarboro, NC 27886-1935
Phone (252) 823-2105

401 A N Main St
Kenansville, NC 28349-8801
Phone (910) 296-0941

401 N Main St
Kenansville, NC 28349-8801
Phone (910) 296-0941

417 N Main St
Kenansville, NC 28349-8801
Phone (910) 296-8080

Merit-based Incentive Payment System (MIPS)

Final score
96.95 of 100Reported as apm
Quality
82.44
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
25519NCMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Vidant Medical Group LLC CurrentSince Feb 1, 2012 Accepting new patients
Tarboro Clinic PA Current Accepting new patients
Edgecombe Health Center by Harborview, LLC Past Accepting new patients

Locations

401 N Main St
Kenansville, NC 28349
Phone (910) 296-0941

101 Clinic Dr
Tarboro, NC 27886
Phone (252) 823-2105

2807 N Main St
Tarboro, NC 27886
Phone (252) 823-8295

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294876800000",
    "number": "1386614162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 CLINIC DR",
            "city": "TARBORO",
            "state": "NC",
            "postal_code": "278861935",
            "telephone_number": "252-823-2105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 CLINIC DR",
            "city": "TARBORO",
            "state": "NC",
            "postal_code": "278861935",
            "telephone_number": "252-823-2105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERS",
        "first_name": "ROBERT",
        "name_suffix": "IV",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-25",
        "last_updated": "2011-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "25519",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8967162",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "29252",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "0152269",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "67162",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080043282",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tarboro, NC

Sources for this page

Verify at the official NPI Registry.