NPIMap

Individual provider Active NPI

Dennis F Peck, MD

  • Anatomic Pathology Physician
  • Olympia, WA
National Provider Identifier
1780645366
Registry record updated Dec 18, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology PhysicianTaxonomy code 207ZP0101X
License
MD00017823 Issued in WA
Practice address
413 Lilly Road NE
Providence St Peter Hospital
Olympia, WA 98506-5166
Phone
(360) 491-9480
Fax
(360) 459-4361
NPI assigned
Mar 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology Physician 207ZP0101X MD00017823 WA Primary

Addresses

Primary practice location

413 Lilly Road NE
Providence St Peter Hospital
Olympia, WA 98506-5166

Mailing address

PO Box 3941
Seattle, WA 98124-3941
Phone (360) 459-7770

Other identifiers 2

IdentifierTypeStateIssuer
8101883MedicaidWA
203967OtherWALABOR & INDUSTRIES

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
MD00017823WAMDAnatomic Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cellnetix Pathology, PLLC Past Accepting new patients
Cellnetix Pathology, PLLC Past Accepting new patients
Cellnetix Pathology, PLLC 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": "1143763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1197936000000",
    "number": "1780645366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3941",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981243941",
            "telephone_number": "360-459-7770",
            "fax_number": "360-459-4361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 LILLY ROAD NE",
            "address_2": "PROVIDENCE ST PETER HOSPITAL",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065166",
            "telephone_number": "360-491-9480",
            "fax_number": "360-459-4361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PECK",
        "first_name": "DENNIS",
        "middle_name": "F",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-31",
        "last_updated": "2007-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0101X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology",
            "state": "WA",
            "license": "MD00017823",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8101883",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRIES",
            "identifier": "203967",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Olympia, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2007; 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.