Kraig Robert Peterson, LGSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

27303 Issued in MN

Practice address

4325 Grand Ave
Duluth, MN 55807-2730

Phone

(218) 722-1497

Fax

(218) 722-6239

NPI assigned

Jul 30, 2018

Last updated

Jan 30, 2024By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MN, WI2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Clinical Social Worker

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lake Superior Community Health CenterGroup PAC ID 6608810031, shared by 3 NPIs, 11 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Lake Superior Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Duluth, MN
  • NPI 1699708297
  Medicare reassignment NPD
• Lake Superior Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Superior, WI
  • NPI 1063789022
  Medicare reassignment NPD
• Lake Superior Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Superior, WI
  • NPI 1578781639
  NPD

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

{
    "created_epoch": "1532908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706572800000",
    "number": "1093293326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2222 E 5TH ST",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "548803709",
            "telephone_number": "715-392-1955",
            "fax_number": "715-392-1935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4325 GRAND AVE",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558072730",
            "telephone_number": "218-722-1497",
            "fax_number": "218-722-6239"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2222 E 5th St",
            "address_purpose": "LOCATION",
            "city": "Superior",
            "state": "WI",
            "postal_code": "548803709",
            "country_code": "US",
            "telephone_number": "715-392-1955",
            "fax_number": "715-392-1935",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "KRAIG",
        "middle_name": "ROBERT",
        "credential": "LGSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-30",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "9522",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "27303",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jillian Peterson, LICSW
• Josey Peterson
• Joshua M Peterson, PA-C
• Katie Beth Peterson, PT
• Keith Hershel Peterson, MD
• Marin E Peterson, CNP
• Meaghan Peterson
• Pamela Peterson
• Robert W Peterson, CRNA
• Ross Leksell Peterson, CRNA

• Clinical Social Worker in Duluth, MN
• Providers in Duluth, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2024; 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.