Active NPI
Lawrence A Peebles, MD
- Surgery Physician
- Kealakekua, HI
National Provider Identifier
1447364807
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- MD3809
- Practice address
- 81-6623 Mamalahoa Hwy
Kealakekua, HI 96750-8130 - Phone
- (808) 323-3855
- Fax
- (808) 323-2994
- NPI assigned
- Aug 19, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | MD3809 | HI | Primary |
Addresses
Primary practice location
81-6623 Mamalahoa Hwy
Kealakekua, HI 96750-8130
Mailing address
81-6623 Mamalahoa Hwy
Kealakekua, HI 96750-8130
Phone (808) 323-3855
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0000BDHGB | Other | HI | PIN |
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 |
|---|---|---|---|
| MD3809 | HI | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Michael B. Russo, MD, Inc | Single Specialty | Past | Accepting new patients |
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": "1155945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1447364807",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "81-6623 MAMALAHOA HWY",
"city": "KEALAKEKUA",
"state": "HI",
"postal_code": "967508130",
"telephone_number": "808-323-3855",
"fax_number": "808-323-2994"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "81-6623 MAMALAHOA HWY",
"city": "KEALAKEKUA",
"state": "HI",
"postal_code": "967508130",
"telephone_number": "808-323-3855",
"fax_number": "808-323-2994"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEEBLES",
"first_name": "LAWRENCE",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Surgery",
"state": "HI",
"license": "MD3809",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PIN",
"identifier": "0000BDHGB",
"state": "HI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kealakekua, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.