Active NPI
Rod H Peterson, M.D.
- Psychiatry Physician
- Spokane, WA
National Provider Identifier
1891744561
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- MD00025600
- Practice address
- 105 W 8TH Ave
Suite 6055
Spokane, WA 99204-2302 - Phone
- (509) 455-9090
- Fax
- (509) 747-2118
- NPI assigned
- May 9, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | MD00025600 | WA | Primary |
Addresses
Primary practice location
105 W 8TH Ave
Suite 6055
Spokane, WA 99204-2302
Mailing address
105 W 8TH Ave
Suite 6055
Spokane, WA 99204-2302
Phone (509) 455-9090
Other practice location 1
107 S Division St
Spokane, WA 99202-1510
Phone (509) 838-4651
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2029663 | Medicaid | WA |
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: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Willamette Valley Clinics LLC | Psychiatry | 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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147132800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548288000000",
"number": "1891744561",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 W 8TH AVE",
"address_2": "SUITE 6055",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992042302",
"telephone_number": "509-455-9090",
"fax_number": "509-747-2118"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 W 8TH AVE",
"address_2": "SUITE 6055",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992042302",
"telephone_number": "509-455-9090",
"fax_number": "509-747-2118"
}
],
"practiceLocations": [
{
"address_1": "107 S Division St",
"address_purpose": "LOCATION",
"city": "Spokane",
"state": "WA",
"postal_code": "992021510",
"country_code": "US",
"telephone_number": "509-838-4651",
"fax_number": "509-363-2762",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PETERSON",
"first_name": "ROD",
"middle_name": "H",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-09",
"last_updated": "2019-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "WA",
"license": "MD00025600",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2029663",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Spokane, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2019; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.