Peter Bern Van Dyck, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

27165 Issued in NC

Practice address

4601 Lake Boone TRL Ste 1B
Raleigh, NC 27607-7503

Phone

(919) 781-1800

Fax

(919) 781-1899

NPI assigned

Oct 4, 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 names 1

• Dr. Peter Bern Dyck Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Nov 28, 2013 through Nov 28, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Peter B. Van Dyck, MD & Associates, PA

  • Psychiatry Physician
  • Raleigh, NC
  • NPI 1255500393
  NPD (past) Authorized official
• Peter B. Van Dyck, MD & Associates, PA

  • Psychiatry Physician
  • Raleigh, NC
  • NPI 1669627493
  NPD (past) Authorized official

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588032000000",
    "number": "1730275470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 80155",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276230155",
            "telephone_number": "919-781-1800",
            "fax_number": "919-781-1899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4601 LAKE BOONE TRL STE 1B",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276077503",
            "telephone_number": "919-781-1800",
            "fax_number": "919-781-1899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DYCK",
        "first_name": "PETER",
        "middle_name": "BERN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2020-04-28",
        "certification_date": "2020-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NC",
            "license": "27165",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PETER",
            "last_name": "DYCK",
            "middle_name": "BERN",
            "prefix": "DR.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Andrea J Valletta, LCSW
• Celina Valletti, D.M.D.
• Aline Lima Van Belois, NP
• Tamsyn Van Biljon
• Christianna Van Dalsen
• Elizabeth Lael Van Dyke
• Kimberly S Van Enk, LCSW
• Jillian Herma Van Essendelft, PA
• Henry Wilson Van Gils Jr., PA-C
• Jonathan Elliott Van Hoose, NP

• Psychiatry Physician in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Psychiatry Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.