Active NPI
Thomas R Peterson, MD
- Anesthesiology Physician
- Chattanooga, TN
National Provider Identifier
1437223237
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- MD17828
- Practice address
- 975 E Third St
Chattanooga, TN 37403-2147 - Phone
- (423) 778-7608
- Fax
- (423) 778-2360
- NPI assigned
- Nov 20, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | MD17828 | TN | Primary |
Addresses
Primary practice location
975 E Third St
Chattanooga, TN 37403-2147
Mailing address
PO Box 11225
Chattanooga, TN 37401-2225
Phone (423) 892-5602
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 009102570 | Medicaid | AL | |
| 3039778 | Other | TN | BLUE CROSS BLUE SHIELD TN |
| 050013519 | Other | TN | MEDICARE RAILROAD |
| 890692J | Medicaid | NC | |
| 3028382 | Medicaid | TN | |
| N348391 | Other | GA | WELLCARE (GA MEDICAID) |
| 000370829C | Medicaid | GA |
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 |
|---|---|---|---|
| MD17828 | TN | MD | Anesthesiology Physician |
| 17828 | TN | MD | Primary Care Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1263427200000",
"number": "1437223237",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 11225",
"city": "CHATTANOOGA",
"state": "TN",
"postal_code": "374012225",
"telephone_number": "423-892-5602",
"fax_number": "423-892-5838"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "975 E THIRD ST",
"city": "CHATTANOOGA",
"state": "TN",
"postal_code": "374032147",
"telephone_number": "423-778-7608",
"fax_number": "423-778-2360"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "THOMAS",
"middle_name": "R",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-20",
"last_updated": "2010-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "TN",
"license": "MD17828",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "009102570",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD TN",
"identifier": "3039778",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "050013519",
"state": "TN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "890692J",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3028382",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLCARE (GA MEDICAID)",
"identifier": "N348391",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000370829C",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chattanooga, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.