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Deactivated NPI 1376657965 Deactivated / Inactive NPI Male Practitioner

Dr. Ernest C Peterson , MD

Surgery • Boise, ID

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Ernest Peterson has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date August 19, 2006
NPI Deactivation Date September 11, 2025
Total Practice Duration ~19 Years of Practice (2006 – 2025)

Professional Overview & Biography Verified Profile Summary

Dr. Ernest Peterson, MD was a registered Surgery practicing in Boise, ID. Throughout an active medical career spanning 19 years, Dr. Peterson provided care at the practice location at 500 W FORT ST until profile deactivation on 2025-09-11.

Practice Location & Contact Primary Location

Practice Address

500 W Fort St

Boise, ID 837024501

Telephone 2084221136
Fax 2084221243
Associated Practice Facility / Clinic
🏢 Boise Vamc Facility NPI 1841258985

Specialty Benchmarks & Practice Insights

Comparative analytics for Surgery in Boise, ID

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 20.5 Yrs
State Avg: 20.2 Yrs
Regional Practice Density
44 Specialists

Practicing in Boise, ID (187 Statewide)

Telehealth Adoption Rate
4.5% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Surgery Primary Specialty

NUCC Taxonomy Code: 208600000X

State License ID M-4978

A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

11 Associated Practitioners
Fredrick Belau , PA-C

Physician Assistant - Surgical

NPI 1033120274

Physician Assistant (Certified)

Annie Fife , NP

Nurse Practitioner - Women's Health

NPI 1144325572

Nurse Practitioner

Douglas Maus , CRNA

Nurse Anesthetist, Certified Registered

NPI 1184730897

Certified Registered Nurse Anesthetist

Karen Mebane , PA-C

Physician Assistant - Surgical

NPI 1255449971

Physician Assistant (Certified)

Sean Jones , PA

Physician Assistant - Surgical

NPI 1275546319

Physician Assistant

Marvin Sparrell , MPAS PA-C

Physician Assistant - Surgical

NPI 1639181233

MPASPAC

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated September 11, 2025

Record deactivated on September 11, 2025

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 08, 2007

Registered at 500 W FORT ST, BOISE, ID 837024501 (Tel: 2084221136)

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Updated Business Mailing Address July 08, 2007

Registered at 7212 AVON ST, BOISE, ID 837044509 (Tel: 2083770129)

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Provider Name / Credentials Updated July 08, 2007

Recorded as ERNEST PETERSON, MD

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Surgery (License #M-4978 in ID)

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Initial NPI Registration & Enumeration August 19, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1376657965
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: August 19, 2006
Last Update: July 08, 2007
Deactivation Date: September 11, 2025

Mailing Address

7212 Avon St

Boise, ID 837044509

Phone: 2083770129

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.