John Peterson, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036083081 Issued in IL

Practice address

2917 Crossing CT
Suite B1
Champaign, IL 61822-6184

Phone

(217) 344-2740

Fax

(217) 344-2819

NPI assigned

Jul 17, 2006

Last updated

Mar 16, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Recovery Options of Champaign County LTD

  dba Recovery Options

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Champaign, IL
  • NPI 1619113974
  Authorized official Same address or phone
• F.a. Wrestler M.D., LTD

  • Health Maintenance Organization
  • Champaign, IL
  • NPI 1740497833
  NPD (past)
• Illiana Emergency Physicians LLP

  • Emergency Medicine Physician
  • Greenville, IL
  • NPI 1730426941
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552694400000",
    "number": "1003833625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2917 CROSSING CT",
            "address_2": "SUITE B1",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618226184",
            "telephone_number": "217-344-2740",
            "fax_number": "217-344-2819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2917 CROSSING CT",
            "address_2": "SUITE B1",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618226184",
            "telephone_number": "217-344-2740",
            "fax_number": "217-344-2819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JOHN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2019-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036083081",
            "primary": false
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "IL",
            "license": "036083081",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036083081",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036083081",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicholas John Peterman
• Kathleen Peters
• Vanessa Ann Peters, MD, PHD
• Petersen Health Care - Illini, LLC (Illini Heritage Rehab & Health Care)
• Jaclyn Annette Petersen, MSW
• Nancy T. Peterson, L.C.S.W.
• Mary Petre
• Tamara Petrovich, PHARMD
• Shantel M Pettigrew
• Shawana Pettigrew

• Internal Medicine Physician in Champaign, IL
• Providers in Champaign, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.