Active NPI
Philip T Peverada, M.D.
- Surgery Physician
- Waterville, ME
National Provider Identifier
1932136207
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 010265
- Practice address
- 325B Kennedy Memorial Dr
Waterville, ME 04901-4562 - Phone
- (207) 861-6550
- Fax
- (207) 861-6551
- NPI assigned
- Jun 26, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 010265 | ME | Primary |
Addresses
Primary practice location
325B Kennedy Memorial Dr
Waterville, ME 04901-4562
Mailing address
325B Kennedy Memorial Dr
Waterville, ME 04901-4562
Phone (207) 861-6550
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932136207 | Medicaid | ME |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 010265 | ME | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Norumbega Medical Specialists, LTD | 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.
-
- Health Service Clinic/Center
- Brewer, ME
- NPI 1780821140
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151280000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350345600000",
"number": "1932136207",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "325B KENNEDY MEMORIAL DR",
"city": "WATERVILLE",
"state": "ME",
"postal_code": "049014562",
"telephone_number": "207-861-6550",
"fax_number": "207-861-6551"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "325B KENNEDY MEMORIAL DR",
"city": "WATERVILLE",
"state": "ME",
"postal_code": "049014562",
"telephone_number": "207-861-6550",
"fax_number": "207-861-6551"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEVERADA",
"first_name": "PHILIP",
"middle_name": "T",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-26",
"last_updated": "2012-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "ME",
"license": "010265",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1932136207",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waterville, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.