Russell Henry Peterson, M.S.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LCPC-3125 Issued in ID

Practice address

2375 E Sunnyside Rd
Suite C
Idaho Falls, ID 83404-8280

Phone

(208) 529-5777

Fax

(208) 529-5778

NPI assigned

Dec 20, 2006

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

Medicare fee-for-service enrollment

Enrolled in UT

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 1

Specialty

Mental Health Counselor

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

John D Perovich PSYD PLLCGroup PAC ID 1850669094, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

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 and National Provider Directory roles.

• John D. Perovich, PSYD PLLC

  • Psychologist
  • Centerville, UT
  • NPI 1265846976

  Mental Health

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1093879637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4360 E 278 N",
            "city": "RIGBY",
            "state": "ID",
            "postal_code": "834425892",
            "telephone_number": "208-359-4775",
            "fax_number": "208-356-5461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2375 E SUNNYSIDE RD",
            "address_2": "SUITE C",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048280",
            "telephone_number": "208-529-5777",
            "fax_number": "208-529-5778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "RUSSELL",
        "middle_name": "HENRY",
        "name_prefix": "Mr.",
        "credential": "M.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "ID",
            "license": "LCPC-3125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Peterson
• Jason M Peterson, DDS
• Jennifer Rae Peterson, LMSW
• Leon C Peterson, O.D.
• Marissa Peterson, MA/CCC-SLP
• Pettingill Counseling PC
• Pettingill Counseling Services
• Pettingill Counseling Services, PC
• Pettingill Counseling Services, Professional Corporation
• Pettingill Counseling Services, Professional Corporation

• Mental Health Counselor in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Mental Health Counselor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.