Individual provider Active NPI

Kevin Jerome Peine, MD

  • Internal Medicine Physician
  • Mesa, AZ
National Provider Identifier
1649541301
Registry record updated Apr 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD2017-0635 Issued in NM
Practice address
6644 E Baywood Ave
Banner Baywood Medical Center
Mesa, AZ 85206
Phone
(480) 321-3900
Fax
(480) 321-3840
NPI assigned
Jan 25, 2012
Last updated
Apr 16, 2019By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 16, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 46381 AZ
Internal Medicine Physician 207R00000X MD2017-0635 NM Primary
Hospitalist Physician 208M00000X 46381 AZ

Addresses

Primary practice location

6644 E Baywood Ave
Banner Baywood Medical Center
Mesa, AZ 85206

Mailing address

PO Box 6210
Farmington, NM 87499-6210
Phone (505) 609-2258

Other identifiers 2

IdentifierTypeStateIssuer
721556MedicaidAZ
34150757MedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, NM2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20120917000567 AZ Practitioner - Internal MedicinePractitioner - Hospitalist 5597913574 Reassigns benefits to 3 organizations
I20170908000376 NM Practitioner - Internal Medicine 5597913574 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Hospitalist
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

37000 N Gantzel Rd
San Tan Valley, AZ 85140-7303
Phone (480) 394-4000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.7 of 100Reported as group
Quality
64.97
Promoting interoperability
98
Improvement activities
40
Cost
69.88

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
46381AZMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Presbyterian Healthcare Services Family Medicine CurrentSince Aug 29, 2017 Accepting new patients
Apogee Medical Group Inc Internal Medicine CurrentSince May 14, 2013 Accepting new patients
Presbyterian Healthcare Services Internal Medicine CurrentSince Aug 29, 2017 Accepting new patients
Banner Hospital Based Physicians Arizona LLC CurrentSince Jul 1, 2015 Accepting new patients
Banner Cancer Center Specialists LLC CurrentSince Oct 7, 2019 Accepting new patients
Banner Cancer Center Specialists LLC CurrentSince Oct 7, 2019 Accepting new patients
San Juan Regional Medical Center Inc Current Accepting new patients
San Juan Regional Medical Center Inc Hospitalist CurrentSince Mar 17, 2019 Accepting new patients
San Juan Regional Medical Center Inc Family Medicine CurrentSince Mar 17, 2019 Accepting new patients
Apogee Medical Group Inc Internal Medicine CurrentSince May 14, 2013 Accepting new patients
Banner Hospital Based Physicians Arizona LLC CurrentSince Jul 1, 2015 Accepting new patients

Locations

2050 W Southern Ave
Apache Junction, AZ 85120
Phone (480) 237-3200

1800 E Florence Blvd
Casa Grande, AZ 85122
Phone (520) 381-6285

1900 N Higley Rd
Gilbert, AZ 85234
Phone (480) 543-2000

2946 E Banner Gateway Dr
Gilbert, AZ 85234
Phone (480) 256-5450

101 Civic Center Ln
Lk Havasu Cty, AZ 86403
Phone (928) 453-0150

6644 E Baywood Ave
Mesa, AZ 85206
Phone (480) 321-2000

6750 E Baywood Ave
Mesa, AZ 85206
Phone (480) 854-5000

807 S Ponderosa St
Payson, AZ 85541
Phone (520) 474-3222

1111 E McDowell Rd
Phoenix, AZ 85006
Phone (602) 239-2000

37000 N Gantzel Rd
San Tan Valley, AZ 85140
Phone (480) 394-4000

1625 N Campbell Ave
Tucson, AZ 85719

1100 Central Ave SE
Albuquerque, NM 87106
Phone (505) 724-6124

8300 Constitution Ave NE
Albuquerque, NM 87110
Phone (505) 291-2000

2200 W 21st St
Clovis, NM 88101
Phone (505) 769-7577

801 W Maple St
Farmington, NM 87401
Phone (505) 325-5011

Organizations & group practices 11

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1327449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555372800000",
    "number": "1649541301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6210",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874996210",
            "telephone_number": "505-609-2258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6644 E BAYWOOD AVE",
            "address_2": "BANNER BAYWOOD MEDICAL CENTER",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "85206",
            "telephone_number": "480-321-3900",
            "fax_number": "480-321-3840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEINE",
        "first_name": "KEVIN",
        "middle_name": "JEROME",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-01-25",
        "last_updated": "2019-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "46381",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NM",
            "license": "MD2017-0635",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "AZ",
            "license": "46381",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "721556",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34150757",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

Verify at the official NPI Registry.