Individual provider Active NPI

Peter M Fitzer, MD

  • Diagnostic Radiology Physician
  • Jupiter, FL
National Provider Identifier
1538248653
Registry record updated Jan 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
ME0062557 Issued in FL
Practice address
115 Ocean Key Way
Jupiter, FL 33477-7359
Phone
(561) 747-8770
Fax
(561) 747-0093
NPI assigned
Nov 2, 2006
Last updated
Jan 19, 2011By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 19, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X ME0062557 FL Primary

Addresses

Primary practice location

115 Ocean Key Way
Jupiter, FL 33477-7359

Mailing address

115 Ocean Key Way
Jupiter, FL 33477-7359
Phone (561) 747-8770

Other identifiers 4

IdentifierTypeStateIssuer
001281500MedicaidFL
2924965MedicaidOH
Q62557MedicaidSC
1025382860001MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20110823001037 GA Practitioner - Diagnostic Radiology 0749363596 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME0062557FLMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Donalsonville Hospital Inc CurrentSince Jul 15, 2011 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
FSH Radiology Inc Diagnostic Radiology Past Accepting new patients

Locations

102 Hospital Cir
Donalsonville, GA 39845
Phone (229) 524-8489

Networks

  • Optimum HealthCare HMO Network

Organizations & group practices 3

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": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295395200000",
    "number": "1538248653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 OCEAN KEY WAY",
            "city": "JUPITER",
            "state": "FL",
            "postal_code": "334777359",
            "telephone_number": "561-747-8770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 OCEAN KEY WAY",
            "city": "JUPITER",
            "state": "FL",
            "postal_code": "334777359",
            "telephone_number": "561-747-8770",
            "fax_number": "561-747-0093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FITZER",
        "first_name": "PETER",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-02",
        "last_updated": "2011-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "FL",
            "license": "ME0062557",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001281500",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2924965",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q62557",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1025382860001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jupiter, FL

Sources for this page

Verify at the official NPI Registry.