Individual provider Active NPI

Matthew M Peter, PH.D.

  • Psychologist
  • Boys Town, NE
National Provider Identifier
1396891230
Registry record updated Aug 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
718 Issued in NE
Practice address
13460 Walsh Dr
Boys Town, NE 68010-7529
Phone
(402) 498-3358
Fax
(402) 498-3375
NPI assigned
Jan 25, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 718 NE Primary

Addresses

Primary practice location

13460 Walsh Dr
Boys Town, NE 68010-7529

Mailing address

13460 Walsh Dr
Boys Town, NE 68010-7529
Phone (402) 498-3358

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140212001032 NE Practitioner - Clinical Psychologist 6305075441 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
718NEMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Father Flanagan'S Boys' Home CurrentSince Mar 1, 2014 Accepting new patients

Locations

14092 Boys Town Hospital Rd
Boys Town, NE 68010
Phone (531) 355-1449

13460 Walsh Dr
Boys Town, NE 68010
Phone (531) 355-3358

14080 Boys Town Hospital Rd
Boys Town, NE 68010
Phone (402) 778-6900

555 N 30th St
Omaha, NE 68131
Phone (402) 280-8100

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.

NPI Registry JSON

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565136000000",
    "number": "1396891230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13460 WALSH DR",
            "city": "BOYS TOWN",
            "state": "NE",
            "postal_code": "680107529",
            "telephone_number": "402-498-3358",
            "fax_number": "402-498-3375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13460 WALSH DR",
            "city": "BOYS TOWN",
            "state": "NE",
            "postal_code": "680107529",
            "telephone_number": "402-498-3358",
            "fax_number": "402-498-3375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETER",
        "first_name": "MATTHEW",
        "middle_name": "M",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-25",
        "last_updated": "2019-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NE",
            "license": "718",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boys Town, NE

Sources for this page

Verify at the official NPI Registry.