NPIMap

Individual provider Active NPI

Stephen M Peskoe, MD

  • Cardiovascular Disease Physician
  • Indianapolis, IN
National Provider Identifier
1750380002
Registry record updated Sep 17, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
01025113A Issued in IN
Practice address
8075 N Shadeland Ave
Suite 200
Indianapolis, IN 46250-2693
Phone
(317) 621-8500
Fax
(317) 621-8501
NPI assigned
Jul 19, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 01025113A IN Primary

Addresses

Primary practice location

8075 N Shadeland Ave
Suite 200
Indianapolis, IN 46250-2693

Mailing address

920 N Shadeland Ave
Suite G1
Indianapolis, IN 46219-4898
Phone (317) 355-9777

Other identifiers 2

IdentifierTypeStateIssuer
100260610AMedicaidIN
4004378OtherINAETNA

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
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01025113AINMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Indiana Heart Associates PC Cardiovascular Disease Past Accepting new patients
Major Hospital Past Accepting new patients
Indiana Heart Associates PC Cardiovascular Disease Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1121731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1253145600000",
    "number": "1750380002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 N SHADELAND AVE",
            "address_2": "SUITE G1",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194898",
            "telephone_number": "317-355-9777",
            "fax_number": "317-355-9760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8075 N SHADELAND AVE",
            "address_2": "SUITE 200",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462502693",
            "telephone_number": "317-621-8500",
            "fax_number": "317-621-8501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PESKOE",
        "first_name": "STEPHEN",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-19",
        "last_updated": "2009-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IN",
            "license": "01025113A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100260610A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4004378",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2009; 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.