NPIMap

Organization Active NPI

Randolph E Peterson

  • Orthopaedic Surgery Physician
  • Ontario, OR
National Provider Identifier
1679752802
Registry record updated Oct 24, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
19969 Issued in OR
Legal business name
RANDOLPH E PETERSON
Practice address
840 SW 4TH Avenue
Ontario, OR 97914-2627
Phone
(541) 889-2899
NPI assigned
Oct 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2007

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

Authorized official

Name
Leslie Peterson
Title
Manager
Phone
(541) 889-2899

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X 19969 OR Primary

Addresses

Primary practice location

840 SW 4TH Avenue
Ontario, OR 97914-2627

Mailing address

PO Box 1460
Ontario, OR 97914-1066
Phone (541) 889-2899

Other identifiers 1

IdentifierTypeStateIssuer
135827MedicaidOR

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1193184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193184000000",
    "number": "1679752802",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 SW 4TH AVENUE",
            "city": "ONTARIO",
            "state": "OR",
            "postal_code": "979142627",
            "telephone_number": "541-889-2899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RANDOLPH E PETERSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-24",
        "last_updated": "2007-10-24",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "541-889-2899"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "OR",
            "license": "19969",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "135827",
            "state": "OR"
        }
    ],
    "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 Oct 24, 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.

Verify at the official NPI Registry.