Individual provider Active NPI

Peter Desmond Gibson

  • Orthopaedic Hand Surgery Physician
  • Flagstaff, AZ
National Provider Identifier
1861758096
Registry record updated Jun 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Hand Surgery PhysicianTaxonomy code 207XS0106X
License
55699 Issued in AZ
Practice address
107 E Oak Ave
Flagstaff, AZ 86001
Phone
(928) 779-7880
NPI assigned
Apr 2, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Hand Surgery Physician 207XS0106X 55699 AZ Primary

Addresses

Primary practice location

107 E Oak Ave
Flagstaff, AZ 86001

Mailing address

1200 N Beaver St
Flagstaff, AZ 86001-3118
Phone (928) 213-6235

Other practice location 1

1485 N Turquoise Dr Ste 200
Flagstaff, AZ 86001
Phone (928) 774-7757

Other identifiers 1

IdentifierTypeStateIssuer
363405MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20180709001700 AZ Practitioner - Orthopedic Surgery 1759637580 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Virginia Commonwealth University, School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Northern Arizona Healthcare CorporationGroup PAC ID 3577473362, 391 clinicians

Practice addresses (Care Compare)

1200 N Beaver St
Flagstaff, AZ 86001-3118
Phone (928) 779-3366

Hospital & facility affiliations

  • Verde Valley Medical Center Hospital, Cottonwood, AZ, CCN 030007
  • Flagstaff Medical Center Hospital, Flagstaff, AZ, CCN 030023

Merit-based Incentive Payment System (MIPS)

Final score
82.13 of 100Reported as group
Quality
66.85
Promoting interoperability
99
Improvement activities
40
Cost
74.4

Procedures performed for Medicare patients

ProcedureNumber of procedures
Knee replacement1-10
Upper limb (arm) arthroscopy (minimally invasive joint repair)29
Removal of tissue1-10
Removal of nail tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
55699AZMDOrthopaedic Hand Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northern Arizona Healthcare Corporation Orthopaedic Surgery CurrentSince Sep 2, 2018 Accepting new patients
Flagstaff Pathology Associates Current Accepting new patients
Northern Arizona Healthcare Corporation CurrentSince Sep 2, 2018 Accepting new patients

Locations

269 S Candy Ln
Cottonwood, AZ 86326
Phone (928) 634-2251

450 S Willard St
Cottonwood, AZ 86326
Phone (928) 649-7991

1215 N Beaver St
Ste 203
Flagstaff, AZ 86001
Phone (928) 773-2249

1485 N Turquoise Dr
Ste 200
Flagstaff, AZ 86001
Phone (928) 774-7757

2000 S Thompson St
Flagstaff, AZ 86001
Phone (928) 213-1051

107 E Oak Ave
Flagstaff, AZ 86001
Phone (928) 779-7880

7810 N US Highway 89
Flagstaff, AZ 86004
Phone (928) 522-8375

107 E Oak Ave
Ste 101
Flagstaff, AZ 86001
Phone (928) 774-1811

1200 N Beaver St
Flagstaff, AZ 86001
Phone (928) 213-6235

107 E Oak Ave
Ste 101201
Flagstaff, AZ 86001
Phone (800) 656-7880

1485 N Turquoise Dr
Ste 220
Flagstaff, AZ 86001
Phone (928) 214-6626

200 Lee St
Winslow, AZ 86047
Phone (928) 226-6400

Organizations & group practices 4

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1333324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560816000000",
    "number": "1861758096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 N BEAVER ST",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860013118",
            "telephone_number": "928-213-6235",
            "fax_number": "928-213-6292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 E OAK AVE",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "86001",
            "telephone_number": "928-779-7880"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1485 N Turquoise Dr Ste 200",
            "address_purpose": "LOCATION",
            "city": "Flagstaff",
            "state": "AZ",
            "postal_code": "86001",
            "country_code": "US",
            "telephone_number": "928-774-7757",
            "fax_number": "928-226-3071",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "PETER",
        "middle_name": "DESMOND",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-02",
        "last_updated": "2019-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XS0106X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Hand Surgery",
            "state": "AZ",
            "license": "55699",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "363405",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Flagstaff, AZ

Sources for this page

Verify at the official NPI Registry.