Thea E Petersen, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD152665 Issued in OR

Practice address

1515 Village Dr Ste 220
Cottage Grove, OR 97424-9700

Phone

(541) 767-5200

Fax

(541) 767-5353

NPI assigned

Apr 10, 2008

Last updated

Apr 10, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

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

Family Practice

Education

University of Washington School of Medicine, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lane County OregonGroup PAC ID 7416853833, 31 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Peacehealth Cottage Grove Community Medical Center Hospital, Cottage Grove, OR, CCN 381301
• Sacred Heart Medical Center - Riverbend Hospital, Springfield, OR, CCN 380102

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Lane County Oregon

  dba Community health Centers of Lane County

  • Federally Qualified Health Center (FQHC)
  • Springfield, OR
  • NPI 1326138314
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Peacehealth

  dba Sacred Heart-RiverBend

  • General Acute Care Hospital
  • Springfield, OR
  • NPI 1083888515
  Care Compare affiliation
• Peacehealth

  • Psychiatric Hospital Unit
  • Eugene, OR
  • NPI 1568236974
  Care Compare affiliation
• Peacehealth

  dba Cottage Grove Community Medical CT

  • Critical Access Hospital
  • Cottage Grove, OR
  • NPI 1902892391
  Care Compare affiliation

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

{
    "created_epoch": "1207785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681084800000",
    "number": "1083887087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 24410",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "97401",
            "telephone_number": "541-984-4301",
            "fax_number": "541-335-2527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 VILLAGE DR STE 220",
            "city": "COTTAGE GROVE",
            "state": "OR",
            "postal_code": "974249700",
            "telephone_number": "541-767-5200",
            "fax_number": "541-767-5353"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "123 S 27th St",
            "address_purpose": "LOCATION",
            "city": "Billings",
            "state": "MT",
            "postal_code": "591014200",
            "country_code": "US",
            "telephone_number": "406-247-3269",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "THEA",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-10",
        "last_updated": "2023-04-10",
        "certification_date": "2023-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD152665",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peacehealth (South Lane Medical Group)
• Peacehealth (Cottage Grove Community Medical CT)
• Mary Peckenpaugh
• Eve Peirce, MS, LPC
• Russell Pennington
• Planned Parenthood of Southwestern Oregon
• Planned Parenthood of Southwestern Oregon
• Jacob A Pleich, MA, QMHP
• Dennis Gere Polzin Jr., DO
• Erik Poyourow, MD

• Family Medicine Physician in Cottage Grove, OR
• Providers in Cottage Grove, OR by specialty
• Family Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2023; 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.