Active NPI
Sandra Graham Peck, EDM RD
- Registered Dietitian
- Acton, MA
National Provider Identifier
1720181118
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 60
- Practice address
- 481 Great Road
Suite 10
Acton, MA 01720 - Phone
- (978) 266-1576
- NPI assigned
- Sep 7, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 60 | MA | Primary |
Addresses
Primary practice location
481 Great Road
Suite 10
Acton, MA 01720
Mailing address
481 Great Road
Suite 10
Acton, MA 01720
Phone (978) 266-1576
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39477 | Other | MA | HARVARD PILGRIM |
| 467468 | Other | MA | TUFTS |
| LD0016 | Other | MA | BLUE CROSS BLUE SHIELD |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60 | MA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157587200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1352332800000",
"number": "1720181118",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "481 GREAT ROAD",
"address_2": "SUITE 10",
"city": "ACTON",
"state": "MA",
"postal_code": "01720",
"telephone_number": "978-266-1576"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "481 GREAT ROAD",
"address_2": "SUITE 10",
"city": "ACTON",
"state": "MA",
"postal_code": "01720",
"telephone_number": "978-266-1576"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PECK",
"first_name": "SANDRA",
"middle_name": "GRAHAM",
"name_prefix": "Mrs.",
"credential": "EDM RD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-07",
"last_updated": "2012-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MA",
"license": "60",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PILGRIM",
"identifier": "39477",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS",
"identifier": "467468",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "LD0016",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Acton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.