Active NPI
Paul D Peterson, PA
- Medical Physician Assistant
- Killeen, TX
National Provider Identifier
1861494486
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA01398
- Practice address
- 2207 S Clear Creek Rd
Ste 304
Killeen, TX 76549-4132 - Phone
- (254) 526-2085
- Fax
- (254) 526-9569
- NPI assigned
- Aug 12, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | PA01398 | TX | |
| Medical Physician Assistant | 363AM0700X | PA01398 | TX | Primary |
Addresses
Primary practice location
2207 S Clear Creek Rd
Ste 304
Killeen, TX 76549-4132
Mailing address
PO Box 4189
Austin Heart
Austin, TX 78765-4189
Phone (512) 206-4300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 85N216 | Other | TX | BC/BS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA01398 | TX | MD | Cardiovascular Disease Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Davids Heart & Vascular, PLLC | Cardiovascular Disease | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Cardiovascular Disease Physician
- Austin, TX
- NPI 1700887700
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123804800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193184000000",
"number": "1861494486",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4189",
"address_2": "AUSTIN HEART",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787654189",
"telephone_number": "512-206-4300",
"fax_number": "512-206-4350"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2207 S CLEAR CREEK RD",
"address_2": "STE 304",
"city": "KILLEEN",
"state": "TX",
"postal_code": "765494132",
"telephone_number": "254-526-2085",
"fax_number": "254-526-9569"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "PAUL",
"middle_name": "D",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-12",
"last_updated": "2007-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "TX",
"license": "PA01398",
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "TX",
"license": "PA01398",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS",
"identifier": "85N216",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Killeen, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.