Tim Gerard Peterson, M.D.

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

020904 Issued in LA

Practice address

1415 Tulane Ave
New Orleans, LA 70112-2600

Phone

(504) 988-2300

Fax

(504) 988-7389

NPI assigned

Aug 15, 2008

Last updated

Feb 24, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Administrators of the Tulane Educational Fund

  dba Tulane University Medical Group

  • Specialist
  • New Orleans, LA
  • NPI 1528014164
  Medicare reassignment NPD
• Administrators of the Tulane Educational Fund

  • Specialist
  • Hattiesburg, MS
  • NPI 1033395298
  NPD
• Administrators of the Tulane Education Fund

  dba Tulane University Medical Group

  • Anatomic Pathology & Clinical Pathology Physician
  • New Orleans, LA
  • NPI 1790354595
  NPD (past)

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

{
    "created_epoch": "1218758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1266969600000",
    "number": "1568618916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1430 TULANE AVE # TW22",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701122632",
            "telephone_number": "504-988-2300",
            "fax_number": "504-988-7389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 TULANE AVE",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701122600",
            "telephone_number": "504-988-2300",
            "fax_number": "504-988-7389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "TIM",
        "middle_name": "GERARD",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-15",
        "last_updated": "2010-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZB0001X",
            "taxonomy_group": "",
            "desc": "Pathology, Blood Banking & Transfusion Medicine",
            "state": "LA",
            "license": "020904",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "LA",
            "license": "020904",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christine Elizabeth Peterson, PA-C
• Diana Moustoukas Peterson, MD
• Halloran Peterson, MD
• Kelley Simone Peterson, CSW
• Marcia Kay Peterson
• Tyler Peterson
• Tyra Peterson, B.A.
• Amonti Amire Petetant
• Angelletta Petit
• Toya Annette Petite, R.N.

• Anatomic Pathology & Clinical Pathology Physician in New Orleans, LA
• Providers in New Orleans, LA by specialty
• Anatomic Pathology & Clinical Pathology Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.