Active NPI
James Andrew Peternell Jr., LMT
- Specialist
- Safety Harbor, FL
National Provider Identifier
1477759652
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MA 47026
- Practice address
- 470 2ND St N # C-1
Safety Harbor, FL 34695-3600 - Phone
- (727) 772-3251
- NPI assigned
- Jun 25, 2007
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | MA 47026 | FL | Primary |
Addresses
Primary practice location
470 2ND St N # C-1
Safety Harbor, FL 34695-3600
Mailing address
470 2ND St N # C-1
Safety Harbor, FL 34695-3600
Phone (727) 772-3251
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MA 47026 | Other | FL | FLORIDA MASSAGE LICENSE # |
| MM 19426 | Other | FL | MASSAGE ESTABLISHMENT LIC |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA 47026 | FL | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182729600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1477759652",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "470 2ND ST N # C-1",
"city": "SAFETY HARBOR",
"state": "FL",
"postal_code": "346953600",
"telephone_number": "727-772-3251"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "470 2ND ST N # C-1",
"city": "SAFETY HARBOR",
"state": "FL",
"postal_code": "346953600",
"telephone_number": "727-772-3251"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERNELL",
"first_name": "JAMES",
"middle_name": "ANDREW",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-06-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "FL",
"license": "MA 47026",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FLORIDA MASSAGE LICENSE #",
"identifier": "MA 47026",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MASSAGE ESTABLISHMENT LIC",
"identifier": "MM 19426",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Safety Harbor, FL
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.