Active NPI
Terry M Peterson, MD
- Family Medicine Physician
- New London, MN
National Provider Identifier
1508832809
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 30171
- Practice address
- 600 Peterson Pkwy
New London, MN 56273-7823 - Phone
- (320) 354-2222
- Fax
- (320) 354-2274
- NPI assigned
- Feb 27, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 30171 | MN | Primary |
Addresses
Primary practice location
600 Peterson Pkwy
New London, MN 56273-7823
Mailing address
600 Peterson Pkwy
New London, MN 56273-7823
Phone (320) 354-2222
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 262890200 | Medicaid | MN |
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)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140998400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1282089600000",
"number": "1508832809",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "600 PETERSON PKWY",
"city": "NEW LONDON",
"state": "MN",
"postal_code": "562737823",
"telephone_number": "320-354-2222",
"fax_number": "320-354-2274"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 PETERSON PKWY",
"city": "NEW LONDON",
"state": "MN",
"postal_code": "562737823",
"telephone_number": "320-354-2222",
"fax_number": "320-354-2274"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "TERRY",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-27",
"last_updated": "2010-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MN",
"license": "30171",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "262890200",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in New London, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.