John M Peterson, PHD, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036051289 Issued in IL

Practice address

600 John Deere Road
Suite 200
Moline, IL 61265-6897

Phone

(309) 779-4200

Fax

(309) 779-4305

NPI assigned

Jan 26, 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1138233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213142400000",
    "number": "1760452189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 JOHN DEERE ROAD",
            "address_2": "SUITE 200",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612656897",
            "telephone_number": "309-779-4200",
            "fax_number": "309-779-4305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 JOHN DEERE ROAD",
            "address_2": "SUITE 200",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612656897",
            "telephone_number": "309-779-4200",
            "fax_number": "309-779-4305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JOHN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "PHD, MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-26",
        "last_updated": "2008-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036051289",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "110028700",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pediatrics Plus. S.C.
• Marie Therese Perez
• David Sigurd Petersen, M.D.
• Karen Petersen, CRT
• Tracy Lynn Petersen
• Kyle W. Peterson, DDS
• Rhonda M Peterson, ACNP
• Erin Leigh Petree, L.C.P.C.
• Brittnie Kole Phillips, LCSW
• Jo Ellyn Phillips, OTR/L

• Internal Medicine Physician in Moline, IL
• Providers in Moline, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2008; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.