Charles Alexander Peebles, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

RL15684 Issued in ND

Practice address

University of North Dakota SMHS Department of Surgery
1301 N Columbia Road, Stop 9037
Grand Forks, ND 58202-9037

Phone

(701) 293-4151

Fax

(701) 293-4148

NPI assigned

Jun 28, 2019

Last updated

Jun 28, 2019By 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1561680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561680000000",
    "number": "1821650904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "UNIVERSITY OF NORTH DAKOTA SMHS DEPARTMENT OF SURGERY",
            "address_2": "1301 N COLUMBIA ROAD, STOP 9037",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582029037",
            "telephone_number": "701-293-4151",
            "fax_number": "701-293-4148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "UNIVERSITY OF NORTH DAKOTA SMHS DEPARTMENT OF SURGERY",
            "address_2": "1301 N COLUMBIA ROAD, STOP 9037",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582029037",
            "telephone_number": "701-293-4151",
            "fax_number": "701-293-4148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEEBLES",
        "first_name": "CHARLES",
        "middle_name": "ALEXANDER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-06-28",
        "last_updated": "2019-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "ND",
            "license": "RL15684",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Pederson
• James Pederson
• Jennifer Ann Pederson, P.T.
• Marshal H Pederson, DC
• Taylorann Pederson
• Bruce Pehl, MD
• Elizabeth Pehl, MD
• Jesse Peltier
• Katie Rothe Pence
• Valerie Jean Pendleton

• Surgery Physician in Grand Forks, ND
• Providers in Grand Forks, ND by specialty
• Surgery Physician in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.