Active NPI
Peter M Gibson, PH.D.
- Psychologist
- Washington, DC
National Provider Identifier
1871678771
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY1191
- Practice address
- 1350 Connecticut Ave NW
Suite 603
Washington, DC 20036-1722 - Phone
- (202) 775-1556
- NPI assigned
- Oct 26, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY1191 | DC | Primary |
| Psychologist | 103T00000X | 0810-001063 | VA |
Addresses
Primary practice location
1350 Connecticut Ave NW
Suite 603
Washington, DC 20036-1722
Mailing address
1350 Connecticut Ave NW
Suite 603
Washington, DC 20036-1722
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Apr 1, 2017 through Apr 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0810-001063 | VA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1871678771",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1350 CONNECTICUT AVE NW",
"address_2": "SUITE 603",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200361722"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1350 CONNECTICUT AVE NW",
"address_2": "SUITE 603",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200361722",
"telephone_number": "202-775-1556"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBSON",
"first_name": "PETER",
"middle_name": "M",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "DC",
"license": "PSY1191",
"primary": true
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "VA",
"license": "0810-001063",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.