NPIMap

Organization Active NPI

Peninsula Imaging L.L.C.

  • Diagnostic Radiology Physician
  • Salisbury, MD
National Provider Identifier
1851359707
Registry record updated May 28, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
PENINSULA IMAGING L.L.C.
Practice address
1655 Woodbrooke Dr
Suite 101
Salisbury, MD 21804-8502
Phone
(410) 749-1123
Fax
(410) 543-1065
NPI assigned
May 2, 2006
Last updated
May 28, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 28, 2009

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

Authorized official

Name
Dr. Peter A. Libby, M.D.NPI 1467408286
Title
President
Phone
(410) 749-1124

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Body Imaging Physician 2085B0100X NU
Nuclear Radiology Physician 2085N0904X NU
Diagnostic Radiology Physician 2085R0202X NU Primary
Diagnostic Ultrasound Physician 2085U0001X NU

Addresses

Primary practice location

1655 Woodbrooke Dr
Suite 101
Salisbury, MD 21804-8502

Mailing address

918 Eastern Shore Dr
Salisbury, MD 21804-6410
Phone (410) 749-1124

Other identifiers 2

IdentifierTypeStateIssuer
8005311MedicaidMD
KB55OtherMDCAREFIRST BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040802000559 MD Part B Supplier - Clinic/Group Practice 7810968286 Receives reassigned benefits from 17 practitioners
Practice locations: Salisbury, MD

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D2005790Peninsula Imaging1655 Woodbrooke Drive Suite 101, Salisbury, MD 21804Certificate of waiverApr 5, 2028

National Provider Directory

National Provider Directory

Locations

30265 Commerce Dr
Unit 102
Millsboro, DE 19966
Phone (443) 679-4433

1655 Woodbrooke Dr
Ste 101
Salisbury, MD 21804
Phone (410) 749-1123

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1146528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243468800000",
    "number": "1851359707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "918 EASTERN SHORE DR",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218046410",
            "telephone_number": "410-749-1124",
            "fax_number": "410-749-1270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1655 WOODBROOKE DR",
            "address_2": "SUITE 101",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218048502",
            "telephone_number": "410-749-1123",
            "fax_number": "410-543-1065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA IMAGING L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-02",
        "last_updated": "2009-05-28",
        "status": "A",
        "authorized_official_last_name": "LIBBY",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "410-749-1124",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2085N0904X",
            "taxonomy_group": "",
            "desc": "Radiology, Nuclear Radiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8005311",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BLUE SHIELD",
            "identifier": "KB55",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salisbury, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.