Gary M Peterson, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

28567 Issued in MN

Practice address

4702 Grand Ave
Duluth, MN 55807-2742

Phone

(218) 249-6800

Fax

(218) 249-6808

NPI assigned

May 6, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MN, WI2 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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: him@slk.direct.slhduluth.com

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Jensen Health LLC

  • Skilled Nursing Facility
  • Duluth, MN
  • NPI 1306588538

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• St. Luke'S Hospital of Duluth

  • Rehabilitation Hospital Unit
  • Duluth, MN
  • NPI 1902845068

  MN

  Medicare reassignment NPD
• St. Luke'S Hospital of Duluth

  • General Acute Care Hospital
  • Superior, WI
  • NPI 1629017793

  WI

  Medicare reassignment NPD
• St. Luke'S Hospital of Duluth

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Duluth, MN
  • NPI 1073480968
  NPD
• St. Luke'S Hospital of Duluth

  • General Acute Care Hospital
  • Duluth, MN
  • NPI 1801835970
  NPD
• Firstsolutions

  • Community/Retail Pharmacy
  • Two Harbors, MN
  • NPI 1780600759
  NPD (past)
• Residential Services of NE MN Inc.

  • Mental Health Counselor
  • Duluth, MN
  • NPI 1821150236
  NPD (past)

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

{
    "created_epoch": "1146873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607040000000",
    "number": "1699724955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4702 GRAND AVE",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558072742",
            "telephone_number": "218-249-6800",
            "fax_number": "218-249-6808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4702 GRAND AVE",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558072742",
            "telephone_number": "218-249-6800",
            "fax_number": "218-249-6808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "GARY",
        "middle_name": "M",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-06",
        "last_updated": "2020-12-04",
        "certification_date": "2020-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "28567",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "611373700",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "him@slk.direct.slhduluth.com",
            "affiliation": "N",
            "address_1": "4702 Grand Ave",
            "city": "Duluth",
            "state": "MN",
            "country_code": "US",
            "postal_code": "558072742",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Craig Norman Peterson
• Danielle Dawn Peterson, LICSW
• Dawn R Peterson, MSW LICSW
• Elizabeth Ann Peterson
• Gabrielle Esther Peterson
• Jillian Peterson, LICSW
• Josey Peterson
• Joshua M Peterson, PA-C
• Katie Beth Peterson, PT
• Keith Hershel Peterson, MD

• All providers in Duluth, MN
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.