Randolph K. Peterson, M.D.

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

40788 Issued in MN

Practice address

6525 France Ave S
Suite 200
Edina, MN 55435-2148

Phone

(952) 927-6501

Fax

(952) 653-1435

NPI assigned

Mar 17, 2006

Last updated

Nov 10, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in MN

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

Specialty

Pathology

Education

University of Minnesota Medical School, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Minnesota Urology, PAGroup PAC ID 0840183984, 83 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

84.84 of 100Reported as group

Quality

64.59

Promoting interoperability

100

Improvement activities

40

Cost

84.88

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/20581/brand/1/csg/1/fhir/r4
• Direct secure messaging: randolph.peterson.1@20581.direct.athenahealth.com

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.

• Minnesota Urology, PA

  dba Metro Urology

  • Urology Physician
  • Woodbury, MN
  • NPI 1912971912
  Medicare reassignment Care Compare group NPD
• Laboratory Medicine Specialists of Duluth

  • Anatomic Pathology & Clinical Pathology Physician
  • Duluth, MN
  • NPI 1891758314
  NPD (past)

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

{
    "created_epoch": "1142553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447113600000",
    "number": "1053380204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6525 FRANCE AVE S",
            "address_2": "SUITE 200",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352148",
            "telephone_number": "952-927-6501",
            "fax_number": "952-653-1435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6525 FRANCE AVE S",
            "address_2": "SUITE 200",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352148",
            "telephone_number": "952-927-6501",
            "fax_number": "952-653-1435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "RANDOLPH",
        "middle_name": "K.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-17",
        "last_updated": "2015-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "MN",
            "license": "40788",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "11-00306",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "525S5PE",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "881029000",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS",
            "identifier": "HP31830",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "220033481",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "984811017049",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kate S Peterson, ATC
• Kelly L. Peterson, OTR/L
• Krista Peterson, PSY.D.L.P.
• Matthew Christian Peterson, DPM
• Michelle C Peterson, MS LMFT
• Robert K Peterson, DDS
• Rodney Holmes Peterson, M.D.
• Stephen Wayne Peterson, LPCC
• Tara Peterson, LICSW, LADC
• Taylor Jones Peterson, PTA

• Anatomic Pathology & Clinical Pathology Physician in Edina, MN
• Providers in Edina, MN by specialty
• Anatomic Pathology & Clinical Pathology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2015; 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.

Verify at the official NPI Registry.