Basic Information
| Provider Information | |||||||||
| NPI: | 1679524904 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICCI | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10700 E GEDDES AVE | ||||||||
| Address2: | NO 200 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801123800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | 7208744462 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 E HAMPDEN AVE | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801132702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | 7208744462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 08/29/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 29742 | TN | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 17633 | HI | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 04-34796 | KS | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 25241 | NE | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 37631 | CO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 02300278 | 05 | NY | MEDICAID | 1679524904 | 05 | ID | MEDICAID | 0000343822 | 01 | HI | HMSA ALL PRODUCTS | OTHER | 300105817 | 01 | CO | RAILROAD MEDICARE MIC | OTHER | 52953343 | 05 | CO | MEDICAID | MD002CO | 05 | AK | MEDICAID | 1679513196 | 05 | UT | MEDICAID | 1679524904 | 05 | WY | MEDICAID | 21183023 | 05 | NM | MEDICAID | 1679524904/7729320 | 05 | SD | MEDICAID | 663883 | 05 | AZ | MEDICAID | 10025709000 | 05 | NE | MEDICAID | 1679524909 | 05 | CT | MEDICAID | 84-059792913 | 05 | NE | MEDICAID | 104686329 | 05 | MI | MEDICAID | CO305959 | 01 | NE | MEDICARE TRAILBLAZER RIN | OTHER | NA1215054 | 01 | NE | RIN WPS MCR NA1215 | OTHER | 300105816 | 01 | CO | RAILROAD MEDICARE RIA | OTHER | NA1214054 | 01 | NE | RIN MCR WPS NA1214 | OTHER | 1679524904 | 05 | MT | MEDICAID | 200424910A | 05 | KS | MEDICAID |