Individual provider Active NPI

Thomas W Peltola, MD

  • Diagnostic Radiology Physician
  • Robbinsdale, MN
National Provider Identifier
1861484040
Registry record updated Jan 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
33813 Issued in MN
Practice address
3300 Oakdale Ave N
Robbinsdale, MN 55422-2926
Phone
(763) 559-2171
Fax
(763) 694-9000
NPI assigned
Aug 16, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2025

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Nuclear Radiology Physician 2085N0904X 33813 MN
Diagnostic Radiology Physician 2085R0202X G200212 CA
Diagnostic Ultrasound Physician 2085U0001X 33813 MN
Diagnostic Radiology Physician 2085R0202X 33813 MN Primary
Neuroradiology Physician 2085N0700X 33813 MN
Body Imaging Physician 2085B0100X 33813 MN

Addresses

Primary practice location

3300 Oakdale Ave N
Robbinsdale, MN 55422-2926

Mailing address

2800 Campus Dr
#10
Plymouth, MN 55441-2645
Phone (763) 559-2171

Other practice location 1

39000 Bob Hope Dr
Rancho Mirage, CA 92270-3221
Phone (760) 674-3850

Other identifiers 1

IdentifierTypeStateIssuer
810702500MedicaidMN

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20241213002981 CA Practitioner - Diagnostic Radiology 8628067279 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Albany Medical College of Union University, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Palm Desert Radiology Medical Group IncGroup PAC ID 0749173789, 125 clinicians

Practice addresses (Care Compare)

39000 Bob Hope Dr
Rancho Mirage, CA 92270-3221
Phone (760) 773-1251

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G200212CAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Palm Desert Radiology Medical Group, Inc Diagnostic Radiology CurrentSince Dec 3, 2024 Accepting new patients
Eisenhower Medical Center Past Accepting new patients

Locations

45280 Seeley Dr
Ste 100A
La Quinta, CA 92253

151 S Sunrise Way
Ste 400
Palm Springs, CA 92262
Phone (760) 674-3583

70390 Highway 111
Rancho Mirage, CA 92270

70380 Highway 111
Rancho Mirage, CA 92270

39000 Bob Hope Dr
Rancho Mirage, CA 92270
Phone (760) 340-3911

72780 Country Club Dr
Ste 106A
Rancho Mirage, CA 92270

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737072000000",
    "number": "1861484040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 CAMPUS DR",
            "address_2": "#10",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554412645",
            "telephone_number": "763-559-2171",
            "fax_number": "763-694-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 OAKDALE AVE N",
            "city": "ROBBINSDALE",
            "state": "MN",
            "postal_code": "554222926",
            "telephone_number": "763-559-2171",
            "fax_number": "763-694-9000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "39000 Bob Hope Dr",
            "address_purpose": "LOCATION",
            "city": "Rancho Mirage",
            "state": "CA",
            "postal_code": "922703221",
            "country_code": "US",
            "telephone_number": "760-674-3850",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PELTOLA",
        "first_name": "THOMAS",
        "middle_name": "W",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-16",
        "last_updated": "2025-01-17",
        "certification_date": "2025-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085N0904X",
            "taxonomy_group": "",
            "desc": "Radiology, Nuclear Radiology",
            "state": "MN",
            "license": "33813",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "G200212",
            "primary": false
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": "MN",
            "license": "33813",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MN",
            "license": "33813",
            "primary": true
        },
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "MN",
            "license": "33813",
            "primary": false
        },
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "MN",
            "license": "33813",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "810702500",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Robbinsdale, MN

Sources for this page

Verify at the official NPI Registry.