Active NPI
Peter C Peterson, PHD
- Psychologist
- Bismarck, ND
National Provider Identifier
1659483089
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 119
- Practice address
- 414 N 7TH St
Bismarck, ND 58501-4423 - Phone
- (701) 323-6543
- Fax
- (701) 323-5709
- NPI assigned
- Aug 31, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 119 | ND | Primary |
Addresses
Primary practice location
414 N 7TH St
Bismarck, ND 58501-4423
Mailing address
PO Box 5501
Bismarck, ND 58506-5501
Phone (701) 323-6000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 16931 | Medicaid | ND |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 119 | ND | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1189468800000",
"number": "1659483089",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5501",
"city": "BISMARCK",
"state": "ND",
"postal_code": "585065501",
"telephone_number": "701-323-6000",
"fax_number": "701-323-5709"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "414 N 7TH ST",
"city": "BISMARCK",
"state": "ND",
"postal_code": "585014423",
"telephone_number": "701-323-6543",
"fax_number": "701-323-5709"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "PETER",
"middle_name": "C",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2007-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "ND",
"license": "119",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "16931",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bismarck, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.