Mark Gordon Peterson, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

2304 Issued in AK

Practice address

500 Indiana Ave
Winslow, AZ 86047-2169

Phone

(928) 289-4646

Fax

(928) 289-6229

NPI assigned

Jan 12, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

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

Interoperability endpoints

• Direct secure messaging: mark.peterson.p3@direct.hpc.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Healthpoint

  • Federally Qualified Health Center (FQHC)
  • Kent, WA
  • NPI 1831199454

  Family Medicine, WA

  Medicare reassignment NPD
• Public Hospital Dist No 1 Skagit

  • General Practice Physician
  • Mount Vernon, WA
  • NPI 1023332749

  WA

  Medicare reassignment NPD
• Healthpoint

  • Federally Qualified Health Center (FQHC)
  • Federal Way, WA
  • NPI 1679575039

  Family Medicine

  NPD
• Healthpoint

  • Federally Qualified Health Center (FQHC)
  • Seattle, WA
  • NPI 1770471377
  NPD
• Public Hospital Dist No 1 Skagit

  • Physical Therapist
  • Mount Vernon, WA
  • NPI 1811460652
  NPD
• South East Alaska Regional Health Consortium

  • Clinic/Center
  • Hydaburg, AK
  • NPI 1073728168
  NPD (past)
• South East Alaska Regional Health Consortium

  • Clinic/Center
  • Wrangel, AK
  • NPI 1487836391
  NPD (past)
• South East Alaska Regional Health Consortium

  • Clinic/Center
  • Kasaan, AK
  • NPI 1962616821
  NPD (past)
• Southeast Alaska Regional Health Consortium

  • Critical Access Hospital
  • Sitka, AK
  • NPI 1720062524
  NPD (past)

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

{
    "created_epoch": "1168560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400803200000",
    "number": "1629129168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 INDIANA AVE",
            "city": "WINSLOW",
            "state": "AZ",
            "postal_code": "860472169",
            "telephone_number": "928-289-4646",
            "fax_number": "928-289-6229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 INDIANA AVE",
            "city": "WINSLOW",
            "state": "AZ",
            "postal_code": "860472169",
            "telephone_number": "928-289-4646",
            "fax_number": "928-289-6229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "MARK",
        "middle_name": "GORDON",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-12",
        "last_updated": "2014-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AK",
            "license": "2304",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MD28841",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jai Mahesh Patel, PHARMD
• Rikesh Amit Patel, DPM
• Michael W Pearson, MD
• Dennis Peters
• Stephanie E Peters, SCHOOL COUNSELOR
• Thayer Starr Phelan, MD
• Lindsey Phillips, RN
• Mary Frances Piercy, CFNP
• Georgia Lynne Polanchek, RN
• Jordan T Price, DO

• All providers in Winslow, AZ
• Family Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2014; 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.