John Peter Petersen, M.D.

Primary specialty

Radiation Oncology PhysicianTaxonomy code 2085R0001X

License

ME 64848 Issued in FL

Practice address

3555 10TH Court
Indian River Regional Cancer Center, Irmc
Vero Beach, FL 32960-4862

Phone

(772) 794-3333

Fax

(772) 569-6949

NPI assigned

Aug 10, 2005

Sex

Male

Sole proprietor

Yes

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)

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.

• Indian River Health Services Inc

  • Internal Medicine Physician
  • Vero Beach, FL
  • NPI 1124074455
  NPD (past)

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

{
    "created_epoch": "1123632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585008000000",
    "number": "1790786895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3555 10TH CT",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329605013",
            "telephone_number": "772-794-3333",
            "fax_number": "772-569-6949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3555 10TH COURT",
            "address_2": "INDIAN RIVER REGIONAL CANCER CENTER, IRMC",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329604862",
            "telephone_number": "772-794-3333",
            "fax_number": "772-569-6949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "JOHN",
        "middle_name": "PETER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-10",
        "last_updated": "2020-03-24",
        "certification_date": "2020-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "FL",
            "license": "ME 64848",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "920004346",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "374792100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Theodore G Perry, MD
• Nancy Ann Peshke, PTA
• Peter a Gold Psy D P a
• Peter G Wernicki M D P a
• Arley A. Peter, M.D.
• Julia Peterson, M.S., CFY-SLP
• Leuna Petitval
• Fred J Petrilla Jr., PHD
• Linda Kay Petrilla, PH.D,
• Claire Petrulak

• Radiation Oncology Physician in Vero Beach, FL
• Providers in Vero Beach, FL by specialty
• Radiation Oncology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2020; 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.