Bryan Peach

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

Practice address

414 4TH Ave NE
Devils Lake, ND 58301-2458

Phone

(701) 662-6767

NPI assigned

Jul 5, 2023

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Amachi Mentoring

  • Substance Abuse Rehabilitation Facility
  • Devils Lake, ND
  • NPI 1366023491
  NPD
• Lake Region Community Shelter

  • Case Management Agency
  • Devils Lake, ND
  • NPI 1114673878
  NPD

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

{
    "created_epoch": "1688515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688515200000",
    "number": "1831877489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "414 4TH AVE NE",
            "city": "DEVILS LAKE",
            "state": "ND",
            "postal_code": "583012458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "414 4TH AVE NE",
            "city": "DEVILS LAKE",
            "state": "ND",
            "postal_code": "583012458",
            "telephone_number": "701-662-6767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEACH",
        "first_name": "BRYAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-07-05",
        "last_updated": "2023-07-05",
        "certification_date": "2023-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172A00000X",
            "taxonomy_group": "",
            "desc": "Driver",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Parisien
• Whitney Parks
• Katarina R Paulson, PEER SUPPORT
• Tamera Paulson
• Elaine Pavek
• Ashley Pederson, DPT
• Reanne Pederson
• Steven L Pederson, DPT
• Daniel Baptiste Peltier
• Kristi Peterson, LCSW

• All providers in Devils Lake, ND
• Peer Specialist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2023; 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.