Mark Peterson

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

30925 Issued in WV

Practice address

111 Great Teays Blvd Ste 101
Scott Depot, WV 25560-9548

Phone

(304) 757-8803

Fax

(304) 757-6904

NPI assigned

May 11, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Valley Health Systems, IncGroup PAC ID 9931017969, shared by 41 NPIs, 110 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• HHC River Park, Inc.

  dba River Park Hospital

  • Psychiatric Hospital
  • Huntington, WV
  • NPI 1477622603
  Medicare reassignment NPD
• Valley Health Systems Inc

  dba Valley Health East Huntington Health Center

  • Federally Qualified Health Center (FQHC)
  • Huntington, WV
  • NPI 1720333461
  Medicare reassignment NPD
• Valley Health Systems Inc

  dba Valley Health Highlawn

  • Federally Qualified Health Center (FQHC)
  • Huntington, WV
  • NPI 1902962368
  Medicare reassignment NPD
• Valley Health Systems, Inc.

  dba Valley Health Milton

  • Federally Qualified Health Center (FQHC)
  • Milton, WV
  • NPI 1548542277
  Medicare reassignment NPD
• Valley Health Systems, Inc.

  dba Valley Health Teays Pediatrics

  • Federally Qualified Health Center (FQHC)
  • Scott Depot, WV
  • NPI 1700446929
  Medicare reassignment
• HHC River Park, Inc.

  • Psychiatric Hospital
  • Huntington, WV
  • NPI 1255360137
  NPD
• Valley Health Systems Inc

  • Clinical Medical Laboratory
  • Huntington, WV
  • NPI 1023083854
  NPD
• Valley Health Systems Inc

  dba Valley Health Hospital Services

  • Obstetrics & Gynecology Physician
  • Huntington, WV
  • NPI 1184699415
  NPD
• Valley Health Systems Inc

  dba Valley Health Hurricane

  • Federally Qualified Health Center (FQHC)
  • Hurricane, WV
  • NPI 1225154206
  NPD
• Valley Health Systems Inc

  dba Cabell Midland Health Center

  • Federally Qualified Health Center (FQHC)
  • Ona, WV
  • NPI 1417923236
  NPD
• Valley Health Systems, Inc.

  • Federally Qualified Health Center (FQHC)
  • Huntington, WV
  • NPI 1508720913
  NPD
• Stallamb P.L.L.C.

  dba Teays Pediatrics P.L.L.C.

  • Pediatric Adolescent Medicine Physician
  • Scott Depot, WV
  • NPI 1245329176
  NPD (past)

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

{
    "created_epoch": "1525996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717027200000",
    "number": "1477043842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1680",
            "city": "HUNTINGTON",
            "state": "WV",
            "postal_code": "257171680",
            "telephone_number": "304-781-5159",
            "fax_number": "304-523-8115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 GREAT TEAYS BLVD STE 101",
            "city": "SCOTT DEPOT",
            "state": "WV",
            "postal_code": "255609548",
            "telephone_number": "304-757-8803",
            "fax_number": "304-757-6904"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1115 20th St Ste 205",
            "address_purpose": "LOCATION",
            "city": "Huntington",
            "state": "WV",
            "postal_code": "257032071",
            "country_code": "US",
            "telephone_number": "304-691-1100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5636 US Route 60 Ste 1B",
            "address_purpose": "LOCATION",
            "city": "Huntington",
            "state": "WV",
            "postal_code": "257052189",
            "country_code": "US",
            "telephone_number": "304-781-5108",
            "fax_number": "304-399-3372",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3729 Teays Valley Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Hurricane",
            "state": "WV",
            "postal_code": "255269705",
            "country_code": "US",
            "telephone_number": "304-760-6040",
            "fax_number": "304-760-6042",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1347 Hillview Dr",
            "address_purpose": "LOCATION",
            "city": "Milton",
            "state": "WV",
            "postal_code": "255411513",
            "country_code": "US",
            "telephone_number": "304-743-1407",
            "fax_number": "304-743-4516",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2585 3rd Ave",
            "address_purpose": "LOCATION",
            "city": "Huntington",
            "state": "WV",
            "postal_code": "257031642",
            "country_code": "US",
            "telephone_number": "304-781-5138",
            "fax_number": "304-781-5139",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "85 Donohoe Dr",
            "address_purpose": "LOCATION",
            "city": "Huntington",
            "state": "WV",
            "postal_code": "257058887",
            "country_code": "US",
            "telephone_number": "304-399-3310",
            "fax_number": "304-523-5416",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "MARK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-11",
        "last_updated": "2024-05-30",
        "certification_date": "2024-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WV",
            "license": "30925",
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "WV",
            "license": "30925",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Josalyne Kayla Osborne
• Lela Owusu, MSW
• Kemberly Pasley
• Donna J Patrick, PT
• Glennis E Peters, LPC
• Deborah Pierro
• Elizabeth Pollastrini
• Sarah Price
• Rebecca Purdy
• Hilari Rader

• Psychiatry Physician in Scott Depot, WV
• Providers in Scott Depot, WV by specialty
• Psychiatry Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.