Peterson Dermatology, S.C.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

PETERSON DERMATOLOGY, S.C.

Practice address

1204 Joseph St # 2
Dodgeville, WI 53533-9670

Phone

(608) 574-5044

NPI assigned

Jan 7, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Jennifer S Peterson, M.D.NPI 1700841178

Title

Dermatologist

Phone

(608) 574-5044

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jennifer S Peterson, MD

  • Dermatology Physician
  • Dodgeville, WI
  • NPI 1700841178
  Medicare reassignment Care Compare group NPD Authorized official
• Sarah M Motl, PA-C

  • Physician Assistant
  • Dodgeville, WI
  • NPI 1407811151
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1420588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1420588800000",
    "number": "1023406493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1204 JOSEPH ST # 2",
            "city": "DODGEVILLE",
            "state": "WI",
            "postal_code": "535339670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1204 JOSEPH ST # 2",
            "city": "DODGEVILLE",
            "state": "WI",
            "postal_code": "535339670",
            "telephone_number": "608-574-5044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSON DERMATOLOGY, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-07",
        "last_updated": "2015-01-07",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "DERMATOLOGIST",
        "authorized_official_telephone_number": "608-574-5044",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Rae Bakken Olinger
• Sadie Olson, RPSGT
• Mikayla Onken, LCSW
• Kari Osterhaus, MSPT
• Ashley Jeanette Parks, RDH
• Jennifer S Peterson, MD
• Brett Michael Petta, PHARMD
• Amy M Philipps, O.T.
• Jeff Pierce, CRNA
• Alan Piper, PT

• Dermatology Physician in Dodgeville, WI
• Providers in Dodgeville, WI by specialty
• Dermatology Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.

Verify at the official NPI Registry.