Individual provider Active NPI

Peter John Terry, M.D.

  • Family Medicine Physician
  • Blaine, MN
National Provider Identifier
1659390490
Registry record updated Aug 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
47287 Issued in MN
Practice address
11855 Ulysses St NE
Blaine, MN 55434-3947
Phone
(763) 785-4200
Fax
(763) 785-8419
NPI assigned
Jul 19, 2006
Last updated
Aug 22, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 47287 MN Primary

Addresses

Primary practice location

11855 Ulysses St NE
Blaine, MN 55434-3947

Mailing address

11855 Ulysses St NE
Blaine, MN 55434-3947
Phone (763) 785-4200

Other practice location 1

205 Wabasha St S
Saint Paul, MN 55107-1805
Phone (952) 853-8800

Other practice location 2

3930 Northwoods Dr
Arden Hills, MN 55112-6963
Phone (952) 853-8800

Other practice location 3

2500 Como Ave
Saint Paul, MN 55108-1460
Phone (952) 853-8800

Other practice location 4

15290 Pennock Ln
Apple Valley, MN 55124-7163
Phone (952) 853-8800

Other practice location 5

8450 Seasons Pkwy
Woodbury, MN 55125-4402
Phone (952) 853-8800

Other identifiers 1

IdentifierTypeStateIssuer
556T0TEOtherMNBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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

Enrollment IDStateProvider typePAC IDDetails
I20050207000504 MN Practitioner - Family Practice 5092766113 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Iowa, RJ & L Carver College of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Group Health IncGroup PAC ID 1759293954, 1,627 clinicians

Practice addresses (Care Compare)

15350 English Ave
Apple Valley, MN 55124-6252
Phone (952) 431-8500

205 Wabasha Ave S
Saint Paul, MN 55107-1805

3930 Northwood Dr
Arden Hills, MN 55112-6963

8600 Nicollet Ave
Bloomington, MN 55420-2824
Phone (952) 884-1148

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Group Health, Inc. CurrentSince Aug 21, 2023 Accepting new patients
Group Health, Inc. Current Accepting new patients
Group Health, Inc. CurrentSince Aug 21, 2023 Accepting new patients

Locations

2220 Riverside Ave
Minneapolis, MN 55454
Phone (612) 371-1600

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

3300 Oakdale Ave N
Robbinsdale, MN 55422
Phone (763) 520-5048

15290 Pennock Ln
Saint Paul, MN 55124
Phone (952) 431-8500

205 Wabasha St S
Saint Paul, MN 55107
Phone (651) 293-8100

2500 Como Ave
Saint Paul, MN 55108
Phone (651) 641-6200

3930 Northwoods Dr
Saint Paul, MN 55112
Phone (651) 490-6775

8450 Seasons Pkwy
Woodbury, MN 55125
Phone (651) 702-5300

Organizations & group practices 3

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 8

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": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692662400000",
    "number": "1659390490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11855 ULYSSES ST NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554343947",
            "telephone_number": "763-785-4200",
            "fax_number": "763-785-8419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11855 ULYSSES ST NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554343947",
            "telephone_number": "763-785-4200",
            "fax_number": "763-785-8419"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "205 Wabasha St S",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551071805",
            "country_code": "US",
            "telephone_number": "952-853-8800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3930 Northwoods Dr",
            "address_purpose": "LOCATION",
            "city": "Arden Hills",
            "state": "MN",
            "postal_code": "551126963",
            "country_code": "US",
            "telephone_number": "952-853-8800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2500 Como Ave",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551081460",
            "country_code": "US",
            "telephone_number": "952-853-8800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "15290 Pennock Ln",
            "address_purpose": "LOCATION",
            "city": "Apple Valley",
            "state": "MN",
            "postal_code": "551247163",
            "country_code": "US",
            "telephone_number": "952-853-8800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8450 Seasons Pkwy",
            "address_purpose": "LOCATION",
            "city": "Woodbury",
            "state": "MN",
            "postal_code": "551254402",
            "country_code": "US",
            "telephone_number": "952-853-8800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TERRY",
        "first_name": "PETER",
        "middle_name": "JOHN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2023-08-22",
        "certification_date": "2023-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "47287",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "556T0TE",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Blaine, MN

Sources for this page

Verify at the official NPI Registry.