Active NPI
Richard Peffley II, D.P.M.
- Foot & Ankle Surgery Podiatrist
- Salem, OR
National Provider Identifier
1386641231
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Foot & Ankle Surgery Podiatrist
- License
- DP00219
- Practice address
- 350 Miller St SE
Salem, OR 97302-4248 - Phone
- (503) 370-8784
- Fax
- (503) 362-4017
- NPI assigned
- Jul 7, 2005
- Reactivated
- Mar 28, 2006
- Last updated
- Jul 9, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Foot & Ankle Surgery Podiatrist | 213ES0103X | DP00219 | OR | Primary |
Addresses
Primary practice location
350 Miller St SE
Salem, OR 97302-4248
Mailing address
350 Miller St SE
Salem, OR 97302-4248
Phone (503) 370-8784
Other identifiers 13
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9535341630000 | Other | OR | TRICARE NORTHWEST PIN |
| 480018560 | Other | OR | RAILROAD RETIREMENT PIN |
| 0001 | Other | OR | WPS TRICARE CLAIMS PIN |
| 480018560 | Other | OR | PALMENTO GBA |
| 953534163002 | Other | OR | UHC PIN |
| DP4Z290 | Other | OR | HEALTH NET PIN |
| 054437000 | Other | OR | REGENCE BLUECROSS BLUESHI |
| 065941 | Medicaid | OR | |
| 1148590001 | Other | OR | DMERC PIN |
| 9535341630000E | Other | OR | MAILHANDLERS PIN |
| 305976 | Other | OR | PROVIDENCE HEALTH PIN |
| 953534163 | Other | OR | ODS PIN |
| V242001 | Other | OR | PACIFIC SOURCE PIN |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DP00219 | OR | MD | Foot & Ankle Surgery Podiatrist |
Organizations & group practices 1
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.
-
dba Salem Foot Clinic
- Foot & Ankle Surgery Podiatrist
- Salem, OR
- NPI 1346213832
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120694400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1386641231",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "350 MILLER ST SE",
"city": "SALEM",
"state": "OR",
"postal_code": "973024248",
"telephone_number": "503-370-8784",
"fax_number": "503-362-4017"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "350 MILLER ST SE",
"city": "SALEM",
"state": "OR",
"postal_code": "973024248",
"telephone_number": "503-370-8784",
"fax_number": "503-362-4017"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEFFLEY",
"first_name": "RICHARD",
"name_prefix": "Dr.",
"name_suffix": "II",
"credential": "D.P.M.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-07",
"last_updated": "2007-07-09",
"deactivation_date": "2006-03-21",
"reactivation_date": "2006-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "213ES0103X",
"taxonomy_group": "",
"desc": "Podiatrist, Foot & Ankle Surgery",
"state": "OR",
"license": "DP00219",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE NORTHWEST PIN",
"identifier": "9535341630000",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD RETIREMENT PIN",
"identifier": "480018560",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WPS TRICARE CLAIMS PIN",
"identifier": "0001",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PALMENTO GBA",
"identifier": "480018560",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UHC PIN",
"identifier": "953534163002",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH NET PIN",
"identifier": "DP4Z290",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUECROSS BLUESHI",
"identifier": "054437000",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "065941",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DMERC PIN",
"identifier": "1148590001",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAILHANDLERS PIN",
"identifier": "9535341630000E",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PROVIDENCE HEALTH PIN",
"identifier": "305976",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ODS PIN",
"identifier": "953534163",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PACIFIC SOURCE PIN",
"identifier": "V242001",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Salem, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.