NPIMap

Individual provider Active NPI

Peter J Tebben, M.D.

  • Endocrinology, Diabetes & Metabolism Physician
  • New Haven, CT
National Provider Identifier
1922085414
Registry record updated Aug 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
78976 Issued in CT
Practice address
20 York St
New Haven, CT 06510-3220
Phone
(507) 316-3594
NPI assigned
Dec 27, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Endocrinology Physician 2080P0205X 78967 CT
Pediatric Endocrinology Physician 2080P0205X 42275 MN
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 78976 CT Primary

Addresses

Primary practice location

20 York St
New Haven, CT 06510-3220

Mailing address

20 York St
New Haven, CT 06510-3220
Phone (507) 316-3594

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, CT2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20041209001078 MN Practitioner - Pediatric MedicinePractitioner - Internal MedicinePractitioner - Endocrinology 3971560079 Reassigns benefits to 1 organization
I20241119000205 CT Practitioner - EndocrinologyPractitioner - Pediatric Medicine 3971560079 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
EndocrinologyAlso: Pediatric Medicine
Education
University of Kansas School of Med (KC/Wich/Sal), 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Yale UniversityGroup PAC ID 9436061736, 2,632 clinicians

Practice addresses (Care Compare)

789 Howard Ave
New Haven, CT 06519-1304
Phone (203) 688-2471

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
78967CTMDPediatric Endocrinology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mayo Clinic CurrentSince Aug 10, 2006 Accepting new patients
Mayo Clinic Current Accepting new patients
Mayo Clinic CurrentSince Aug 10, 2006 Accepting new patients
Yale University CurrentSince Oct 31, 2024 Accepting new patients
Yale University CurrentSince Oct 31, 2024 Accepting new patients
Floyd County Memorial Hospital Commission Past Accepting new patients

Locations

800 Howard Ave
New Haven, CT 06519
Phone (203) 785-2140

50 Division St
New Haven, CT 06511
Phone (203) 785-2140

20 York St
North Haven, CT 06510
Phone (203) 688-2433

789 Howard Ave
North Haven, CT 06519
Phone (203) 688-2471

200 1st St SW
Rochester, MN 55905
Phone (507) 266-4850

Interoperability endpoints

  • Direct secure messaging: ptebben693094@direct.ynhh.org

Organizations & group practices 6

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 9

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": "1135641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724284800000",
    "number": "1922085414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 YORK ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065103220",
            "telephone_number": "507-316-3594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 YORK ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065103220",
            "telephone_number": "507-316-3594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEBBEN",
        "first_name": "PETER",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-27",
        "last_updated": "2024-08-22",
        "certification_date": "2024-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0205X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Endocrinology",
            "state": "CT",
            "license": "78967",
            "primary": false
        },
        {
            "code": "2080P0205X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Endocrinology",
            "state": "MN",
            "license": "42275",
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "CT",
            "license": "78976",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Haven, CT

Sources for this page

Verify at the official NPI Registry.