Steven Warren Peterson, D.O.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

L7110 Issued in TX

Practice address

1315 Waters Edge Dr
Suite # 107
Granbury, TX 76048-1300

Phone

(817) 579-5476

Fax

(817) 579-5489

NPI assigned

Jul 10, 2006

Last updated

Aug 16, 2011By the provider in NPPES

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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/8568/brand/1/csg/1/fhir/r4

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.

• Saint Peter's University Hospital

  • General Acute Care Hospital
  • New Brunswick, NJ
  • NPI 1114924834
  NPD (past)

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1313452800000",
    "number": "1730113317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1315 WATERS EDGE DR",
            "address_2": "SUITE # 107",
            "city": "GRANBURY",
            "state": "TX",
            "postal_code": "760481300",
            "telephone_number": "817-579-5476",
            "fax_number": "817-579-5489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1315 WATERS EDGE DR",
            "address_2": "SUITE # 107",
            "city": "GRANBURY",
            "state": "TX",
            "postal_code": "760481300",
            "telephone_number": "817-579-5476",
            "fax_number": "817-579-5489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "STEVEN",
        "middle_name": "WARREN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2011-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TX",
            "license": "L7110",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "219230401",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1254425",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pecan Valley MHMR Region
• Pecan Valley MHMR Region
• Peter K Krone MD PA
• Peter K Krone MD, PA
• Justus Turner Peters, M.D.
• Courtney Phillips, DC
• Katharine Phillips
• Physical Management Professionals (Therapy Heroes)
• Brett Picciotti, D.O.
• Jennifer Joyce Pickett, NP-C

• Surgery Physician in Granbury, TX
• Providers in Granbury, TX by specialty
• Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2011; 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.