Active NPI
Randolph E Peterson, MD
- Orthopaedic Surgery Physician
- Ontario, OR
National Provider Identifier
1669461364
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- License
- 19969
- Practice address
- 840 SW 4TH Ave
Ontario, OR 97914-2627 - Phone
- (541) 889-2899
- Fax
- (541) 889-2883
- NPI assigned
- Oct 17, 2005
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | 19969 | OR | Primary |
Addresses
Primary practice location
840 SW 4TH Ave
Ontario, OR 97914-2627
Mailing address
PO Box 1460
Ontario, OR 97914-1066
Phone (541) 889-2899
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 135827 | Medicaid | OR | |
| 838281001 | Other | OR | BCBS OF OR |
| 003426400 | Other | ID | IDAHO MEDICAID EDS |
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 Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19969 | OR | MD | Orthopaedic Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| John D Foote | Orthopaedic Surgery | Past | Accepting new patients |
| Saint Alphonsus Medical Center- Ontario Inc | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Orthopaedic Surgery Physician
- Ontario, OR
- NPI 1104005347
-
dba Saint Alphonsus Medical Center Ontario
- General Acute Care Hospital
- Ontario, OR
- NPI 1891891792
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129507200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1669461364",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1460",
"city": "ONTARIO",
"state": "OR",
"postal_code": "979141066",
"telephone_number": "541-889-2899",
"fax_number": "541-889-2883"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "840 SW 4TH AVE",
"city": "ONTARIO",
"state": "OR",
"postal_code": "979142627",
"telephone_number": "541-889-2899",
"fax_number": "541-889-2883"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "RANDOLPH",
"middle_name": "E",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-10-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "OR",
"license": "19969",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "135827",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF OR",
"identifier": "838281001",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IDAHO MEDICAID EDS",
"identifier": "003426400",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ontario, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.