Individual provider Active NPI

Peter W Thompson, MD

  • Interventional Pain Medicine Physician
  • Bangor, ME
National Provider Identifier
1508809492
Registry record updated Jan 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
016287 Issued in ME
Practice address
1365 Broadway
Bangor, ME 04401-2401
Phone
(207) 942-6226
Fax
(207) 992-2756
NPI assigned
Jun 14, 2006
Last updated
Jan 18, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) Physician 207LP2900X 016287 ME
Interventional Pain Medicine Physician 208VP0014X 016287 ME Primary

Addresses

Primary practice location

1365 Broadway
Bangor, ME 04401-2401

Mailing address

1365 Broadway
Bangor, ME 04401-2401
Phone (207) 942-6226

Other identifiers 1

IdentifierTypeStateIssuer
432219799MedicaidME

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
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

Enrollment IDStateProvider typePAC IDDetails
I20060130000767 ME Practitioner - Interventional Pain Management 9335160977 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
016287MEMDInterventional Pain Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Pain Management, PC Pain Medicine CurrentSince Jan 11, 2006 Accepting new patients
Lakes Region Anesthesiology PA Past Accepting new patients

Locations

1365 Broadway
Bangor, ME 04401
Phone (207) 942-2233

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674000000000",
    "number": "1508809492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1365 BROADWAY",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044012401",
            "telephone_number": "207-942-6226",
            "fax_number": "207-992-2756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1365 BROADWAY",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044012401",
            "telephone_number": "207-942-6226",
            "fax_number": "207-992-2756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMPSON",
        "first_name": "PETER",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2023-01-18",
        "certification_date": "2023-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "ME",
            "license": "016287",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "ME",
            "license": "016287",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "432219799",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bangor, ME

Sources for this page

Verify at the official NPI Registry.