Tatiana Lvovna Peterson, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD00042246 Issued in WA

Practice address

2121 NE 139TH St
Vancouver, WA 98686-2316

Phone

(360) 487-1000

Fax

(360) 487-5239

NPI assigned

Jan 19, 2007

Sex

Female

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 1

Medicare fee-for-service enrollment

Enrolled in WA, OR2 enrollments

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 2

Specialty

Geriatric MedicineAlso: Internal Medicine

Education

Other, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Legacy Salmon Creek HospitalGroup PAC ID 0446295711, 309 clinicians

The Vancouver Clinic Inc PSGroup PAC ID 3173436490, 580 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Legacy Salmon Creek Medical Center Hospital, Vancouver, WA, CCN 500150

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Legacy Salmon Creek Hospital

  • Clinic/Center
  • Vancouver, WA
  • NPI 1356357784
  Medicare reassignment Care Compare group NPD
• The Vancouver Clinic Inc PS

  • Internal Medicine Physician
  • Vancouver, WA
  • NPI 1992759427
  Medicare reassignment Care Compare group NPD
• Legacy Clinics LLC

  • Clinic/Center
  • Portland, OR
  • NPI 1902827272

  Internal Medicine

  Medicare reassignment NPD
• Legacy Salmon Creek Hospital

  • General Acute Care Hospital
  • Vancouver, WA
  • NPI 1700809829
  NPD
• The Vancouver Clinic Inc PS

  • Ambulatory Surgical Clinic/Center
  • Vancouver, WA
  • NPI 1306556907
  NPD
• The Vancouver Clinic Inc PS

  • Eyewear Supplier
  • Ridgefield, WA
  • NPI 1760004477
  NPD
• Legacy Clinics LLC

  • Rural Health Clinic/Center
  • Sandy, OR
  • NPI 1730472192
  NPD
• The Vancouver Clinic Pharmacy

  • Pharmacist
  • Vancouver, WA
  • NPI 1336365857
  NPD (past)

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

• Legacy Salmon Creek Hospital

  • Clinic/Center
  • Vancouver, WA
  • NPI 1356357784

  Hospital

  Care Compare affiliation
• Legacy Salmon Creek Hospital

  • General Acute Care Hospital
  • Vancouver, WA
  • NPI 1700809829
  Care Compare affiliation

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1243987200000",
    "number": "1114070455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 NE 139TH ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986862316",
            "telephone_number": "360-487-1000",
            "fax_number": "360-487-5239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 NE 139TH ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986862316",
            "telephone_number": "360-487-1000",
            "fax_number": "360-487-5239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "TATIANA",
        "middle_name": "LVOVNA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-19",
        "last_updated": "2009-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD00042246",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8374563",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberly Kay Peterson
• Kirsten Renae Peterson
• Margret Anne Marie Peterson, LMHCA, MA
• Maya Grace Peterson
• Sarah Jane Peterson, LMT
• Tina Lynn Louie Peterson, CRNA
• Tod C Peterson
• Anna Michelle Petrey
• Heather Ann Petrik, RN
• Lyndsey Tyler Petrino

• Internal Medicine Physician in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Internal Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2009; 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.