Timothy D Peterson, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

81-285 Issued in NM

Practice address

108 Sutton Place
Taos Ski Valley, NM 87525-0067

Phone

(575) 766-8421

Fax

(575) 776-8942

NPI assigned

Nov 21, 2005

Last updated

Jul 12, 2016By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NM, AK3 enrollments

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 3

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Timothy D Peterson, MD PC

  dba Mogul Medical Urgent Care

  • Urgent Care Clinic/Center
  • Taos Ski Valley, NM
  • NPI 1073818555

  O20100930040166

  Same enrollment

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/2956/brand/1/csg/1/fhir/r4
• Direct secure messaging: timothy.peterson.1@2956.direct.athenahealth.com

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Bartlett Regional Hospital

  dba Bartlett Home Health and Hospice

  • Community Based Hospice Care Agency
  • Juneau, AK
  • NPI 1437840576

  Contracted Managing Employee

  CMS ownership

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.

• Timothy D Peterson, MD PC

  dba Mogul Medical Urgent Care

  • Urgent Care Clinic/Center
  • Taos Ski Valley, NM
  • NPI 1073818555

  Emergency Medicine

  Medicare reassignment NPD
• Juneau Emergency Medical Associates, Inc.

  • Emergency Medicine Physician
  • Juneau, AK
  • NPI 1912393356
  Medicare reassignment NPD

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

{
    "created_epoch": "1132531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468281600000",
    "number": "1528041886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 67",
            "address_2": "108 SUTTON PLACE",
            "city": "TAOS SKI VALLEY",
            "state": "NM",
            "postal_code": "875250067",
            "telephone_number": "575-766-8421",
            "fax_number": "575-776-8942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 SUTTON PLACE",
            "city": "TAOS SKI VALLEY",
            "state": "NM",
            "postal_code": "875250067",
            "telephone_number": "575-766-8421",
            "fax_number": "575-776-8942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "TIMOTHY",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-21",
        "last_updated": "2016-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AK",
            "license": "2528",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NM",
            "license": "81-285",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33282",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• William Leonard Blevins, MD
• Alicia L Gonzales, MD
• Kama Rickett, D.C.
• Timothy D Peterson, MD PC (Mogul Medical Urgent Care)

• Emergency Medicine Physician in Taos Ski Valley, NM
• Providers in Taos Ski Valley, NM by specialty
• Emergency Medicine Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.