Active NPI
Pete Mayfield IV, M.D.
- Internal Medicine Physician
- Clarksville, IN
National Provider Identifier
1396700647
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 01034928A
- Practice address
- 2051 Clevidence Blvd
Clarksville, IN 47129-2278 - Phone
- (812) 280-9145
- Fax
- (812) 280-6641
- NPI assigned
- Apr 19, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 23401 | KY | |
| Internal Medicine Physician | 207R00000X | 01034928A | IN | Primary |
Addresses
Primary practice location
2051 Clevidence Blvd
Clarksville, IN 47129-2278
Mailing address
PO Box 776351
Chicago, IL 60677-6351
Phone (502) 588-9490
Other identifiers 10
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1193576 | Other | KY | CHA / NCMA |
| 64234016 | Medicaid | KY | |
| 004329 | Other | SIHO - NCMA | |
| 000023031D | Other | KY | HUMANA / NCMA |
| 1166748 | Other | PASSPORT - NCMA | |
| 2440087000 | Other | PAD - NCMA | |
| 100097290 | Medicaid | IN | |
| 110138280 | Other | IN | RRMCR - NCMA |
| 2533699 | Other | KY | CIGNA / NCMA |
| 00000062915 | Other | ANTHEM - NCMA |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | pmayfield5194@direct.nortonhealthcare.org | ||
| FHIR URL | https://epicsoap.nortonhealthcare.org/ |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23401 | KY | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Medical Associates, Inc. | Past | Accepting new patients |
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 and National Provider Directory roles.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145404800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1611100800000",
"number": "1396700647",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 776351",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606776351",
"telephone_number": "502-588-9490",
"fax_number": "502-272-5116"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2051 CLEVIDENCE BLVD",
"city": "CLARKSVILLE",
"state": "IN",
"postal_code": "471292278",
"telephone_number": "812-280-9145",
"fax_number": "812-280-6641"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAYFIELD",
"first_name": "PETE",
"name_suffix": "IV",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-19",
"last_updated": "2021-01-20",
"certification_date": "2021-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "KY",
"license": "23401",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IN",
"license": "01034928A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHA / NCMA",
"identifier": "1193576",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64234016",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SIHO - NCMA",
"identifier": "004329",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HUMANA / NCMA",
"identifier": "000023031D",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PASSPORT - NCMA",
"identifier": "1166748",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PAD - NCMA",
"identifier": "2440087000",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100097290",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RRMCR - NCMA",
"identifier": "110138280",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA / NCMA",
"identifier": "2533699",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM - NCMA",
"identifier": "00000062915",
"state": null
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "pmayfield5194@direct.nortonhealthcare.org",
"affiliation": "N",
"address_1": "2051 Clevidence Blvd",
"city": "Clarksville",
"state": "IN",
"country_code": "US",
"postal_code": "471292278",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://epicsoap.nortonhealthcare.org/",
"affiliation": "N",
"address_1": "2051 Clevidence Blvd",
"city": "Clarksville",
"state": "IN",
"country_code": "US",
"postal_code": "471292278",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Clarksville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.