Gilman Peterson III, DMD MD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

7976 Issued in KY

Practice address

1303 W Lexington Ave
Winchester, KY 40391-3100

Phone

(859) 744-0677

NPI assigned

Jul 9, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Oral Surgery

Education

University of Kentucky College of Medicine, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Oral Surgery and Implant AssociatesGroup PAC ID 5395115786, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Oral Surgery & Implant Associates

  • Oral and Maxillofacial Surgery (Dentist)
  • Winchester, KY
  • NPI 1649900465
  Medicare reassignment Care Compare group NPD
• Erena & Peterson, PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Lexington, KY
  • NPI 1285942649
  Medicare reassignment
• Oral Surgery & Implant Associates

  • Oral and Maxillofacial Surgery (Dentist)
  • Mt Sterling, KY
  • NPI 1689304404
  NPD
• Gregory R. Erena, P.S.C.

  • Oral and Maxillofacial Surgery (Dentist)
  • Lexington, KY
  • NPI 1801893888
  NPD (past)

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

{
    "created_epoch": "1215561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1299628800000",
    "number": "1871756924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 E HIGH ST",
            "city": "MT STERLING",
            "state": "KY",
            "postal_code": "403531267",
            "telephone_number": "859-498-6204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1303 W LEXINGTON AVE",
            "city": "WINCHESTER",
            "state": "KY",
            "postal_code": "403913100",
            "telephone_number": "859-744-0677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "GILMAN",
        "name_suffix": "III",
        "credential": "DMD MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-09",
        "last_updated": "2011-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KY",
            "license": "7976",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "KY",
            "license": "7976",
            "primary": true
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "KY",
            "license": "7976",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100071380",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100067490",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pdow Dre LLC
• Mia Renee Pelfrey, PHARMD
• Yvonne Marie Pendleton, LMT
• Erik Robert Perez
• Michael Jeffrey Perlmutter, MD
• Vicci Phillips, MS/LPCC
• Suzanne Marie Pica, MD
• Pippen Optometry, P.S.C.
• Patrick L. Pippen, O.D.
• Nicole L Plank, PTA

• Oral and Maxillofacial Surgery (Dentist) in Winchester, KY
• Providers in Winchester, KY by specialty
• Oral and Maxillofacial Surgery (Dentist) in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2011; 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.
• 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.