Active NPI
David L Peterman, MD
- Pediatrics Physician
- Meridian, ID
National Provider Identifier
1942245840
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- M4174
- Practice address
- 3280 E Lanark Dr
Meridian, ID 83642-5982 - Phone
- (208) 377-4400
- Fax
- (208) 377-4416
- NPI assigned
- Jun 17, 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | M4174 | ID | Primary |
Addresses
Primary practice location
3280 E Lanark Dr
Meridian, ID 83642-5982
Mailing address
PO Box 191050
Boise, ID 83719-1050
Phone (208) 377-4400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003885200 | Medicaid | ID |
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M4174 | ID | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Saint Alphonsus Regional Medical Center Inc | Past | Accepting new patients | |
| Alliance Medical Group, LLC | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Family Medicine Physician
- Boise, ID
- NPI 1487326203
-
- Psychiatric Hospital Unit
- Boise, ID
- NPI 1770687857
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150502400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1580256000000",
"number": "1942245840",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 191050",
"city": "BOISE",
"state": "ID",
"postal_code": "837191050",
"telephone_number": "208-377-4400",
"fax_number": "208-377-4416"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3280 E LANARK DR",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836425982",
"telephone_number": "208-377-4400",
"fax_number": "208-377-4416"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERMAN",
"first_name": "DAVID",
"middle_name": "L",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-17",
"last_updated": "2020-01-29",
"certification_date": "2020-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "ID",
"license": "M4174",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003885200",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Meridian, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.