Kathryn Elizabeth Peterschmidt, D.M.D

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D10093 Issued in OR

Practice address

6395 Keizer Station Blvd NE
#101
Keizer, OR 97303-2305

Phone

(971) 267-2033

NPI assigned

Aug 3, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1407024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1448236800000",
    "number": "1609285774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 W WASHINGTON ST.",
            "city": "STAYTON",
            "state": "OR",
            "postal_code": "97383",
            "telephone_number": "503-769-2788",
            "fax_number": "503-769-2728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6395 KEIZER STATION BLVD NE",
            "address_2": "#101",
            "city": "KEIZER",
            "state": "OR",
            "postal_code": "973032305",
            "telephone_number": "971-267-2033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSCHMIDT",
        "first_name": "KATHRYN",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-03",
        "last_updated": "2015-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D10093",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hannah Payseno, CPM, LDM
• Megan E Peck, DMD
• Pelton Project, Inc.
• Justin Michael Pennington, DPT, PT
• Garland Perry
• Mary E Pfotzer-Greenwood, LMT
• Christian Phillips, PT, DPT
• Adelaide Anne Pierce
• Angela Pileggi, RPH
• Pinnacle Physical Therapy PC

• General Practice Dentistry in Keizer, OR
• Providers in Keizer, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2015; 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.