Ryan C Peterson MD Inc

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

License

A103097 Issued in CA

Legal business name

RYAN C PETERSON MD INC

Practice address

3209 Hillock Dr
Los Angeles, CA 90068-1427

Phone

(310) 266-3774

Fax

(323) 380-7420

NPI assigned

Apr 12, 2011

Organization subpart

No

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

Authorized official

Name

Ryan C Peterson, MDNPI 1669613816

Title

Direct Owner

Phone

(310) 266-3774

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ryan Curtis Peterson, M.D.

  • Addiction Medicine (Psychiatry & Neurology) Physician
  • Los Angeles, CA
  • NPI 1669613816

  Pain Medicine

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1302566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581292800000",
    "number": "1609166545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7001",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "913577001",
            "telephone_number": "818-888-7815",
            "fax_number": "818-715-1722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3209 HILLOCK DR",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900681427",
            "telephone_number": "310-266-3774",
            "fax_number": "323-380-7420"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8300 Valley Circle Blvd Ste C",
            "address_purpose": "LOCATION",
            "city": "West Hills",
            "state": "CA",
            "postal_code": "913043023",
            "country_code": "US",
            "telephone_number": "310-266-3774",
            "fax_number": "323-380-7420",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5620 Wilbur Ave Ste 207",
            "address_purpose": "LOCATION",
            "city": "Tarzana",
            "state": "CA",
            "postal_code": "913561309",
            "country_code": "US",
            "telephone_number": "818-344-0070",
            "fax_number": "818-344-0079",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5400 Balboa Blvd Ste 111",
            "address_purpose": "LOCATION",
            "city": "Encino",
            "state": "CA",
            "postal_code": "913165206",
            "country_code": "US",
            "telephone_number": "818-784-8975",
            "fax_number": "818-784-2035",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "42051 10th St W Ste 109",
            "address_purpose": "LOCATION",
            "city": "Lancaster",
            "state": "CA",
            "postal_code": "935347093",
            "country_code": "US",
            "telephone_number": "818-501-2001",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "16030 Ventura Blvd Ste 150",
            "address_purpose": "LOCATION",
            "city": "Encino",
            "state": "CA",
            "postal_code": "914362779",
            "country_code": "US",
            "telephone_number": "818-501-2001",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "22900 Ventura Blvd Ste 340",
            "address_purpose": "LOCATION",
            "city": "Woodland Hills",
            "state": "CA",
            "postal_code": "913645808",
            "country_code": "US",
            "telephone_number": "310-266-3774",
            "fax_number": "323-380-7420",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3101 Ocean Park Blvd Ste 309",
            "address_purpose": "LOCATION",
            "city": "Santa Monica",
            "state": "CA",
            "postal_code": "904053022",
            "country_code": "US",
            "telephone_number": "310-266-3774",
            "fax_number": "323-380-7420",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7966 Beverly Blvd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900484511",
            "country_code": "US",
            "telephone_number": "310-266-3774",
            "fax_number": "323-380-7420",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "RYAN C PETERSON MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-12",
        "last_updated": "2020-02-10",
        "certification_date": "2020-02-10",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "DIRECT OWNER",
        "authorized_official_telephone_number": "310-266-3774",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "CA",
            "license": "A103097",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pain Medicine (Anesthesiology) Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Pain Medicine (Anesthesiology) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.