Connor Peck, DDS

Primary specialty

Orofacial Pain DentistryTaxonomy code 1223X2210X

License

R713 Issued in MN

Practice address

515 Delaware St SE
Minneapolis, MN 55455-0357

Phone

(612) 626-0140

NPI assigned

Jun 13, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

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

Oral SurgeryAlso: Sleep Medicine

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

LMG, IncGroup PAC ID 6305851676, 5 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Froedtert Memorial Lutheran Hospital Hospital, Milwaukee, WI, CCN 520177

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• LMG, Inc

  • Oral and Maxillofacial Pathology Dentistry
  • Wauwatosa, WI
  • NPI 1134235427
  Medicare reassignment Care Compare group
• Affiliated Health of Wisconsin LTD.

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Wauwatosa, WI
  • NPI 1063433977
  NPD

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

• Froedtert Memorial Lutheran Hospital, Inc.

  • General Acute Care Hospital
  • Milwaukee, WI
  • NPI 1255334173
  Care Compare affiliation

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

{
    "created_epoch": "1528848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570320000000",
    "number": "1821581760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2410 UNIVERSITY AVE W STE 110",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551141978",
            "telephone_number": "414-416-2110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 DELAWARE ST SE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554550357",
            "telephone_number": "612-626-0140"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "515 Delaware St SE",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554550357",
            "country_code": "US",
            "telephone_number": "612-626-0140",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PECK",
        "first_name": "CONNOR",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-13",
        "last_updated": "2019-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "R713",
            "primary": false
        },
        {
            "code": "1223X2210X",
            "taxonomy_group": "",
            "desc": "Dentist, Orofacial Pain",
            "state": "MN",
            "license": "R713",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Teresa L Pearson
• Daniel Fellows Pease, M.D.
• Kayla Marie Pease, MA, LPCC, RPT
• Sheree Joanne Pechacek, APRN, CNP
• Victoria Pechacek, AUD, CCC-A
• Daniel Edwin Peck, M.D.
• Elizabeth Stacey Peck, R.D. L.D.
• Jennifer Lee Peck, RN
• Pamela J Peck, CMT
• Chad Peckels, D.C.

• Orofacial Pain Dentistry in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Orofacial Pain Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2019; 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.