Penny Petersen

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

000437 Issued in SD

Practice address

525 N Foster St
Mitchell, SD 57301-2966

Phone

(605) 995-2000

NPI assigned

Jan 18, 2006

Sex

Female

Sole proprietor

No

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.

• Avera Queen of Peace

  • Hospitalist Physician
  • Mitchell, SD
  • NPI 1205359031

  SD

  Medicare reassignment NPD
• Avera Queen of Peace

  • Specialist
  • Mitchell, SD
  • NPI 1053548982
  NPD
• Avera Queen of Peace

  • Critical Access Hospital
  • Wessington Springs, SD
  • NPI 1316942204
  NPD
• Avera Queen of Peace

  • Rural Health Clinic/Center
  • Howard, SD
  • NPI 1326043092
  NPD (past)

Medicare fee-for-service enrollment

Enrolled in SD

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: penny.petersen@avera.sdhealthlink.net

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 26, 2010.

{
    "created_epoch": "1137542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1267142400000",
    "number": "1114907979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 N FOSTER ST",
            "city": "MITCHELL",
            "state": "SD",
            "postal_code": "573012966",
            "telephone_number": "605-995-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 N FOSTER ST",
            "city": "MITCHELL",
            "state": "SD",
            "postal_code": "573012966",
            "telephone_number": "605-995-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "PENNY",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-18",
        "last_updated": "2010-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SD",
            "license": "000437",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6831840",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "S1639",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Xenofon Papadopoulos, M.D.
• Paula'S Hearing Aid Services LLC
• Kally Paulsen
• Pediatrics Plus LLC
• Ashley Faye Peters, D.O.
• Craig Allen Pickart, D.C.
• Heather Pieper
• Jaclyn Plamp, PHARMD
• Kari Pommer
• Prairie Family Healthcare, P.C.

• All providers in Mitchell, SD
• Nurse Practitioner in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2010; 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.

Verify at the official NPI Registry.