NPIMap

Individual provider Active NPI

Richard Nicholas Peterson, PA

  • Medical Physician Assistant
  • Eloy, AZ
National Provider Identifier
1386949659
Registry record updated Jan 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
4680 Issued in AZ
Practice address
1705 E Hanna Rd
Eloy, AZ 85131-9612
Phone
(520) 464-3067
NPI assigned
Jan 18, 2011
Last updated
Jan 18, 2011By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 18, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 4680 AZ Primary

Addresses

Primary practice location

1705 E Hanna Rd
Eloy, AZ 85131-9612

Mailing address

1932 S Falcon Dr
Gilbert, AZ 85295-5869
Phone (480) 734-6261

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20120416000249 AZ Practitioner - Physician Assistant 5092976274 Reassigns benefits to 3 organizations
I20200116001226 TX Practitioner - Physician Assistant 5092976274 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Urgent Care Arizona LLC CurrentSince Mar 10, 2018 Accepting new patients
Emergency Professional Services PC CurrentSince Mar 1, 2025 Accepting new patients
Tuba City Regional Health Care Corporation CurrentSince Dec 9, 2019 Accepting new patients
Ton Sells Hospital CurrentSince Apr 14, 2023 Accepting new patients
Tuba City Regional Health Care Corporation CurrentSince Dec 9, 2019 Accepting new patients
Emergency Professional Services PC CurrentSince Mar 1, 2025 Accepting new patients
Ucxtra Umbrella, LLC Past Accepting new patients
Ton Sells Hospital Past Accepting new patients

Locations

2050 W Southern Ave
Apache Junction, AZ 85120
Phone (480) 237-3200

1676 E McMurray Blvd
Ste 1
Casa Grande, AZ 85122
Phone (520) 316-0688

1111 E McDowell Rd
Phoenix, AZ 85006
Phone (602) 239-2000

37000 N Gantzel Rd
San Tan Valley, AZ 85140
Phone (480) 394-4000

7900 S J Stock Rd
Tucson, AZ 85746
Phone (520) 295-2550

Organizations & group practices 12

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": "1295308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295308800000",
    "number": "1386949659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1932 S FALCON DR",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852955869",
            "telephone_number": "480-734-6261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 E HANNA RD",
            "city": "ELOY",
            "state": "AZ",
            "postal_code": "851319612",
            "telephone_number": "520-464-3067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "RICHARD",
        "middle_name": "NICHOLAS",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-01-18",
        "last_updated": "2011-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "4680",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eloy, AZ

Sources for this page

Verify at the official NPI Registry.