Richard P Stadter Psychiatric Center, LLC

Primary specialty

Psychiatric HospitalTaxonomy code 283Q00000X

License

5066A Issued in ND

Legal business name

RICHARD P STADTER PSYCHIATRIC CENTER, LLC

Practice address

1451 44TH Ave S Ste a
Grand Forks, ND 58201-3434

Phone

(701) 772-2500

Fax

(701) 787-8996

NPI assigned

Jun 4, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Thomas Peterson, MDNPI 1639131014

Title

President/ Chief Medical Officer

Phone

(701) 772-2500

Specialties & licenses 1

Addresses

Other identifiers 4

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Thomas Michael Peterson, MD

  • Psychiatry Physician
  • Grand Forks, ND
  • NPI 1639131014
  NPD Authorized official

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

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435104000000",
    "number": "1831137389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1451 44TH AVE S",
            "address_2": "PO BOX 14354",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582013434",
            "telephone_number": "701-772-2500",
            "fax_number": "701-732-2685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1451 44TH AVE S STE A",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582013434",
            "telephone_number": "701-772-2500",
            "fax_number": "701-787-8996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICHARD P STADTER PSYCHIATRIC CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-04",
        "last_updated": "2015-06-24",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT/ CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "701-772-2500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "ND",
            "license": "5066A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01426",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NDBCBS",
            "identifier": "12039",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MNBCBS",
            "identifier": "2F78HRI",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "712617400",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lynn M Reynolds Cooley
• Andrea Marie Reynolds, M.S., CCC-SLP
• Jennifer Marie Reynolds, RN
• Jim Dale Rhoads, LSW
• Freaha Riaz, MD
• Paula Ricke, FNP-C
• Amanda Rickett, MS, CFY-SLP
• Julie Ann Riddle, LICSW
• Andrea Marie Riendeau, FNP-C
• Brianna Rike, MOT, OTR/L

• Psychiatric Hospital in Grand Forks, ND
• Providers in Grand Forks, ND by specialty
• Psychiatric Hospital in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2015; 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.