NPIMap

Individual provider Active NPI

Arlin Ray Peterson, DPM

  • Podiatrist
  • Pueblo, CO
National Provider Identifier
1396721544
Registry record updated Feb 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
648 Issued in CO
Practice address
509 Colorado Ave
Ste D
Pueblo, CO 81004-2008
Phone
(719) 544-5958
Fax
(719) 544-5991
NPI assigned
Dec 20, 2005
Last updated
Feb 19, 2008By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 19, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 648 CO Primary
Podiatrist 213E00000X 3476040501 UT

Addresses

Primary practice location

509 Colorado Ave
Ste D
Pueblo, CO 81004-2008

Mailing address

509 Colorado Ave
Ste D
Pueblo, CO 81004-2008
Phone (719) 544-5958

Other identifiers 2

IdentifierTypeStateIssuer
P00250683OtherRAILROAD
19907541MedicaidCO

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050505000370 CO Practitioner - Podiatry 4587638267 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
California School of Podiatric Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2037 Jerry Murphy Rd
Suite 100
Pueblo, CO 81001-1256
Phone (719) 544-5958

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Removal of tissue59
Removal of nail tissue172
Removal or shaving of skin growth39

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3476040501UTMDPodiatrist
648COMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
Ap Foot and Ankle Specialists PC Podiatrist CurrentSince Oct 1, 2004 Accepting new patients

Locations

2037 Jerry Murphy Rd
Ste 100
Pueblo, CO 81001
Phone (719) 544-5958

509 Colorado Ave
Ste D
Pueblo, CO 81004
Phone (719) 544-5958

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.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1135036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1203379200000",
    "number": "1396721544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 COLORADO AVE",
            "address_2": "STE D",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810042008",
            "telephone_number": "719-544-5958",
            "fax_number": "719-544-5991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 COLORADO AVE",
            "address_2": "STE D",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810042008",
            "telephone_number": "719-544-5958",
            "fax_number": "719-544-5991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "ARLIN",
        "middle_name": "RAY",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-20",
        "last_updated": "2008-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "CO",
            "license": "648",
            "primary": true
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "UT",
            "license": "3476040501",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "P00250683",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "19907541",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

Verify at the official NPI Registry.