NPIMap

Individual provider Active NPI

Barry John Peterson, D.O.

  • Otolaryngology/Facial Plastic Surgery Physician
  • Rexburg, ID
National Provider Identifier
1447456272
Registry record updated Jun 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology/Facial Plastic Surgery PhysicianTaxonomy code 207YX0905X
License
O-0522 Issued in ID
Practice address
256 N 2ND E
Rexburg, ID 83440-1638
Phone
(208) 656-9646
Fax
(208) 656-9645
NPI assigned
Jun 27, 2007
Last updated
Jun 11, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy Physician 207KA0200X O-0522 ID
Otolaryngology/Facial Plastic Surgery Physician 207YX0905X O-0522 ID Primary

Addresses

Primary practice location

256 N 2ND E
Rexburg, ID 83440-1638

Mailing address

256 N 2ND E
Rexburg, ID 83440-1638
Phone (208) 656-9646

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090624000089 ID Practitioner - OtolaryngologyPractitioner - Allergy/ImmunologyPractitioner - Plastic and Reconstructive Surgery 9234027343 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
OtolaryngologyAlso: Allergy/Immunology
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Upper Valley ENT and Allergy PLLCGroup PAC ID 5092949594, 3 clinicians

Practice addresses (Care Compare)

256 N 2ND
Rexburg, ID 83440-1638
Phone (208) 656-9646

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Madison Ear Nose and Throat Clinic Otolaryngology Current Accepting new patients
Utah Head and Neck Surgery PastSince Jan 1, 1990 Accepting new patients
Daniel Anesthesia PC Past Accepting new patients
Upper Valley Surgery Center Past Accepting new patients

Locations

30 Madison Professional Park
Rexburg, ID 83440
Phone (208) 356-4459

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/AGECCA/Endpoint/AGECCA

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1182902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402444800000",
    "number": "1447456272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "256 N 2ND E",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834401638",
            "telephone_number": "208-656-9646",
            "fax_number": "208-656-9645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "256 N 2ND E",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834401638",
            "telephone_number": "208-656-9646",
            "fax_number": "208-656-9645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "BARRY",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-27",
        "last_updated": "2014-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207KA0200X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology, Allergy",
            "state": "ID",
            "license": "O-0522",
            "primary": false
        },
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "ID",
            "license": "O-0522",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rexburg, ID

Sources for this page

Verify at the official NPI Registry.