Active NPI
Gregory James Peterson, M.D.
- Family Medicine Physician
- Fergus Falls, MN
National Provider Identifier
1790844009
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 020301
- Practice address
- 1505 Pebble Lake Rd
Suite 500
Fergus Falls, MN 56537-3800 - Phone
- (218) 736-1884
- Fax
- (218) 736-1880
- NPI assigned
- Dec 6, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 020301 | MN | Primary |
Addresses
Primary practice location
1505 Pebble Lake Rd
Suite 500
Fergus Falls, MN 56537-3800
Mailing address
1505 Pebble Lake Rd
Suite 500
Fergus Falls, MN 56537-3800
Phone (218) 736-1884
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 436777400 | Medicaid | MN |
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 020301 | MN | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165363200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1252454400000",
"number": "1790844009",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1505 PEBBLE LAKE RD",
"address_2": "SUITE 500",
"city": "FERGUS FALLS",
"state": "MN",
"postal_code": "565373800",
"telephone_number": "218-736-1884",
"fax_number": "218-736-1880"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1505 PEBBLE LAKE RD",
"address_2": "SUITE 500",
"city": "FERGUS FALLS",
"state": "MN",
"postal_code": "565373800",
"telephone_number": "218-736-1884",
"fax_number": "218-736-1880"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "GREGORY",
"middle_name": "JAMES",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-06",
"last_updated": "2009-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MN",
"license": "020301",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "436777400",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fergus Falls, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 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.