Active NPI
John William Peterson, M.D.
- Family Medicine Physician
- East Machias, ME
National Provider Identifier
1578616967
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 008942
- Practice address
- 893 Main Street
East Machias, ME 04963-0893 - Phone
- (207) 255-0102
- Fax
- (207) 255-4645
- NPI assigned
- Jan 19, 2007
- Last updated
- Mar 9, 2010
- 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 | 008942 | ME | Primary |
Addresses
Primary practice location
893 Main Street
East Machias, ME 04963-0893
Mailing address
21 Court Street
Machias, ME 04654
Phone (207) 255-4253
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 124490099 | Medicaid | ME |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 008942 | ME | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169164800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1268092800000",
"number": "1578616967",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21 COURT STREET",
"city": "MACHIAS",
"state": "ME",
"postal_code": "04654",
"telephone_number": "207-255-4253",
"fax_number": "207-255-4539"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "893 MAIN STREET",
"city": "EAST MACHIAS",
"state": "ME",
"postal_code": "049630893",
"telephone_number": "207-255-0102",
"fax_number": "207-255-4645"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "JOHN",
"middle_name": "WILLIAM",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-19",
"last_updated": "2010-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "ME",
"license": "008942",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "124490099",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in East Machias, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 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.