NPIMap

Organization Active NPI

John T Peterson DDS PC

  • Dentist
  • Kankakee, IL
National Provider Identifier
1437436664
Registry record updated Nov 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
19A14762 Issued in IL
Legal business name
JOHN T PETERSON DDS PC
Practice address
200 E Court St
Suite 504
Kankakee, IL 60901-3843
Phone
(815) 932-3613
NPI assigned
Nov 16, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2011

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

Authorized official

Name
John T Peterson, DDSNPI 1720035702
Title
Dentist
Phone
(815) 932-3613

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 19A14762 IL Primary

Addresses

Primary practice location

200 E Court St
Suite 504
Kankakee, IL 60901-3843

Mailing address

200 E Court St
Suite 504
Kankakee, IL 60901-3843
Phone (815) 932-3613

Other identifiers 3

IdentifierTypeStateIssuer
1003311MedicaidIL
606970OtherILUNITED CONCORDIA
021076OtherILFIRST COMMONWEALTH

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1321401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321401600000",
    "number": "1437436664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E COURT ST",
            "address_2": "SUITE 504",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609013843",
            "telephone_number": "815-932-3613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 E COURT ST",
            "address_2": "SUITE 504",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609013843",
            "telephone_number": "815-932-3613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN T PETERSON DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-16",
        "last_updated": "2011-11-16",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "815-932-3613",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "19A14762",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1003311",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "606970",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST COMMONWEALTH",
            "identifier": "021076",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kankakee, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.