Peter D Fedor, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

4301061885 Issued in MI

Practice address

872 Munson Ave
Suite B
Traverse City, MI 49686-3638

Phone

(231) 947-1690

Fax

(231) 947-1692

NPI assigned

Oct 16, 2005

Last updated

Mar 2, 2015By the provider in NPPES

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 4

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Ophthalmology

Education

Other, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Munson Healthcare Cadillac Hospital Hospital, Cadillac, MI, CCN 230081

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Great Lakes Eye Consultants PLC

  • Ophthalmology Physician
  • Traverse City, MI
  • NPI 1164552972
  Medicare reassignment NPD Authorized official
• Dean & Aubry Optometrists PC

  dba Ausable Eyecare

  • Optometrist
  • Grayling, MI
  • NPI 1891701157
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Munson Healthcare Cadillac

  dba Munson Healthcare Cadillac Physician Network

  • Family Medicine Physician
  • Cadillac, MI
  • NPI 1487051611

  Hospital

  Care Compare affiliation
• Munson Healthcare Cadillac

  • General Acute Care Hospital
  • Cadillac, MI
  • NPI 1841696754
  Care Compare affiliation

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

{
    "created_epoch": "1129420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425254400000",
    "number": "1821087560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 308",
            "city": "ACME",
            "state": "MI",
            "postal_code": "496100308",
            "telephone_number": "231-947-1690",
            "fax_number": "231-947-1692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "872 MUNSON AVE",
            "address_2": "SUITE B",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496863638",
            "telephone_number": "231-947-1690",
            "fax_number": "231-947-1692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FEDOR",
        "first_name": "PETER",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-16",
        "last_updated": "2015-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MI",
            "license": "4301061885",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104609651",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104609660",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104609642",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104609633",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julie Fawaz
• Faye E. Youker, PLLC
• Roche J Featherstone, M.D.
• Christine Anne Fechter
• Margaret Jean Fedder, LLPC
• Brian N Feeney, DDS
• David S Feenstra, M.D.
• Matthew James Feil
• Neal H Fellows, D.O.
• Abbey Marie Felski

• Ophthalmology Physician in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Ophthalmology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2015; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.