Active NPI
Lars E Peterson, MD
- Internal Medicine Physician
- Laramie, WY
National Provider Identifier
1023110640
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 6962A
- Practice address
- 255 N 30TH St
Laramie, WY 82072-5140 - Phone
- (307) 742-2141
- NPI assigned
- Sep 3, 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 6962A | WY | Primary |
Addresses
Primary practice location
255 N 30TH St
Laramie, WY 82072-5140
Mailing address
320 S 7TH St
Laramie, WY 82070-3822
Phone (307) 399-2883
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 119117900 | Medicaid | WY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040326001211 | WY | Practitioner - Internal Medicine | 0648162321 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Internal Medicine
- Education
- Creighton University School of Medicine, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Ivinson Memorial Hospital
Practice addresses (Care Compare)
255 N 30TH St
Laramie, WY 82072-5140
Phone (307) 742-2142
Hospital & facility affiliations
- Ivinson Memorial Hospital
- Medical Center of the Rockies
Merit-based Incentive Payment System (MIPS)
- Final score
- 85.68 of 100
- Quality
- 75.73
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 76.55
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6962A | WY | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ivinson Memorial Hospital | Current | Accepting new patients | |
| Ivinson Memorial Hospital | Current | Accepting new patients |
Locations
3116 Willett Dr
Laramie, WY 82072
Phone (307) 742-6319
255 N 30th St
Laramie, WY 82072
Phone (307) 742-2141
Organizations & group practices 5
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.
-
- Rural Acute Care Hospital
- Laramie, WY
- NPI 1366626269
-
- Rural Acute Care Hospital
- Laramie, WY
- NPI 1336289552
-
- Rural Acute Care Hospital
- Laramie, WY
- NPI 1912181827
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Laramie, WY
- NPI 1952585861
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157241600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1351641600000",
"number": "1023110640",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "320 S 7TH ST",
"city": "LARAMIE",
"state": "WY",
"postal_code": "820703822",
"telephone_number": "307-399-2883"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "255 N 30TH ST",
"city": "LARAMIE",
"state": "WY",
"postal_code": "820725140",
"telephone_number": "307-742-2141"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "LARS",
"middle_name": "E",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-03",
"last_updated": "2012-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "WY",
"license": "6962A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "119117900",
"state": "WY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Laramie, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2012; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.