NPIMap

Individual provider Active NPI

Gavin Paul Peters, PA

  • Physician Assistant
  • Oconto Falls, WI
National Provider Identifier
1467087148
Registry record updated Aug 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5323 Issued in WI
Practice address
107 E Highland Dr
Oconto Falls, WI 54154-1002
Phone
(920) 846-3092
Fax
(920) 846-8313
NPI assigned
Mar 3, 2020
Last updated
Aug 28, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X
Physician Assistant 363A00000X 5323 WI Primary

Addresses

Primary practice location

107 E Highland Dr
Oconto Falls, WI 54154-1002

Mailing address

PO Box 1866
Green Bay, WI 54305-1866
Phone (920) 445-7222

Other practice location 1

307 Manor Dr
Suring, WI 54174-9182
Phone (920) 842-2144

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20211008001184 WI Practitioner - Physician Assistant 2860890662 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

107 E Highland Dr
Oconto Falls, WI 54154-1002
Phone (920) 846-3092

307 Manor Dr
Suring, WI 54174-9182
Phone (920) 842-2144

820 Arbutus Ave
Oconto, WI 54153-2004
Phone (920) 835-1100

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5323WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Bellin Memorial Hospital Inc CurrentSince Sep 28, 2021 Accepting new patients
Oconto Hospital & Medical Center Inc CurrentSince Sep 28, 2021 Accepting new patients
Bellin Memorial Hospital Inc CurrentSince Sep 28, 2021 Accepting new patients
Oconto Hospital & Medical Center Inc CurrentSince Sep 28, 2021 Accepting new patients
Oconto Hospital & Medical Center Inc Past Accepting new patients

Locations

744 S Webster Ave
Green Bay, WI 54301
Phone (920) 433-6025

820 Arbutus Ave
Oconto, WI 54153
Phone (920) 835-1100

107 E Highland Dr
Oconto Falls, WI 54154
Phone (920) 846-0509

307 Manor Dr
Suring, WI 54174
Phone (920) 842-2144

Interoperability endpoints

  • Direct secure messaging: gpeters313439@direct.thedacare.org
  • Direct secure messaging: gpeters917107@direct.emplifyhealth.org

Organizations & group practices 6

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 4

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": "1583193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756339200000",
    "number": "1467087148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1866",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543051866",
            "telephone_number": "920-445-7222",
            "fax_number": "920-445-7289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 E HIGHLAND DR",
            "city": "OCONTO FALLS",
            "state": "WI",
            "postal_code": "541541002",
            "telephone_number": "920-846-3092",
            "fax_number": "920-846-8313"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "307 Manor Dr",
            "address_purpose": "LOCATION",
            "city": "Suring",
            "state": "WI",
            "postal_code": "541749182",
            "country_code": "US",
            "telephone_number": "920-842-2144",
            "fax_number": "920-842-4111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERS",
        "first_name": "GAVIN",
        "middle_name": "PAUL",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-03",
        "last_updated": "2025-08-28",
        "certification_date": "2025-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "5323",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oconto Falls, WI

Sources for this page

Verify at the official NPI Registry.