Active NPI
Stacy Peterson
- Dentist
- Erie, CO
National Provider Identifier
1093444804
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DEN.00205330
- Practice address
- 1927 Colorado State Hwy 7
Suite 101
Erie, CO 80516 - Phone
- (720) 874-9039
- NPI assigned
- Jun 7, 2022
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | DEN.00205330 | CO | Primary |
Addresses
Primary practice location
1927 Colorado State Hwy 7
Suite 101
Erie, CO 80516
Mailing address
11605 Destination Dr Apt 5404
Broomfield, CO 80021-4793
Phone (701) 426-9415
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DEN.00205330 | CO | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sunrise Community Health | Current | Accepting new patients | |
| Sunrise Community Health | Current | Accepting new patients | |
| Sunrise Community Health | Current | Accepting new patients | |
| Erie Modern Dentistry, LLP | Dentist | Past | Accepting new patients |
Locations
2930 11th Ave
Evans, CO 80620
Phone (970) 350-4606
302 3rd St SE
Ste 150
Loveland, CO 80537
Phone (970) 669-4855
Interoperability endpoints
- stacy.peterson.1@27043.direct.athenahealth.com
Organizations & group practices 4
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.
-
dba Loveland Community Health Clinic
- Federally Qualified Health Center (FQHC)
- Loveland, CO
- NPI 1902005382
-
dba North Loveland Community Health Center
- Federally Qualified Health Center (FQHC)
- Loveland, CO
- NPI 1700690252
-
dba SummitStone Clinic
- Federally Qualified Health Center (FQHC)
- Loveland, CO
- NPI 1750660726
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1654560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661904000000",
"number": "1093444804",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11605 DESTINATION DR APT 5404",
"city": "BROOMFIELD",
"state": "CO",
"postal_code": "800214793",
"telephone_number": "701-426-9415"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1927 COLORADO STATE HWY 7",
"address_2": "SUITE 101",
"city": "ERIE",
"state": "CO",
"postal_code": "80516",
"telephone_number": "720-874-9039"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "STACY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-06-07",
"last_updated": "2022-08-31",
"certification_date": "2022-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CO",
"license": "DEN.00205330",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Erie, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2022; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.