Individual provider Active NPI

Daniel P Peterson, M.D.

  • Diagnostic Radiology Physician
  • Staten Island, NY
National Provider Identifier
1407833973
Registry record updated Aug 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
192643 Issued in NY
Practice address
360 Bard Ave
Staten Island, NY 10310-1666
Phone
(718) 876-2000
Fax
(718) 876-2006
NPI assigned
Dec 27, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 192643 NY Primary

Addresses

Primary practice location

360 Bard Ave
Staten Island, NY 10310-1666

Mailing address

360 Bard Ave
Staten Island, NY 10310-1666
Phone (718) 876-2000

Other identifiers 1

IdentifierTypeStateIssuer
01542209MedicaidNY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dpatterson90403@nyumc.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, FL2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040713001367 NY Practitioner - Diagnostic Radiology 1658359799 Reassigns benefits to 2 organizations
I20260603003005 FL Practitioner - Diagnostic Radiology 1658359799 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New York UniversityGroup PAC ID 1355232422, 5,925 clinicians

Practice addresses (Care Compare)

111 Broadway
New York, NY 10006-1901
Phone (212) 263-9700

13303 Jamaica Ave
Jamaica, NY 11418-2618
Phone (718) 206-6923

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.8 of 100Reported as group
Quality
91.79
Promoting interoperability
100
Improvement activities
40
Cost
75.18

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
192643NYMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
New York University CurrentSince Mar 13, 2014 Accepting new patients
New York University CurrentSince Mar 13, 2014 Accepting new patients

Locations

13303 Jamaica Ave
#13292
Richmond Hill, NY 11418
Phone (718) 291-3276

13303 Jamaica Ave
Richmond Hill, NY 11418
Phone (718) 206-6942

4849 Arthur Kill Rd
#P
Staten Island, NY 10309
Phone (718) 876-2000

3917 Richmond Ave
Staten Island, NY 10312
Phone (718) 876-2000

360 Bard Ave
Staten Island, NY 10310
Phone (718) 876-2000

355 Bard Ave
Staten Island, NY 10310
Phone (718) 818-1380

14 Wall St
Fl 9
Wall Street, NY 10005
Phone (646) 501-3224

Interoperability endpoints

  • Direct secure messaging: dpatterson90403@nyumc.direct-ci.com

Organizations & group practices 2

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.

Hospital & facility affiliations 9

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": "1135641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661817600000",
    "number": "1407833973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 BARD AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103101666",
            "telephone_number": "718-876-2000",
            "fax_number": "718-876-2006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 BARD AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103101666",
            "telephone_number": "718-876-2000",
            "fax_number": "718-876-2006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "DANIEL",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-27",
        "last_updated": "2022-08-30",
        "certification_date": "2022-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "192643",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01542209",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dpatterson90403@nyumc.direct-ci.com",
            "affiliation": "N",
            "address_1": "360 Bard Ave",
            "city": "Staten Island",
            "state": "NY",
            "country_code": "US",
            "postal_code": "103101666",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.