Randal J. Peterson, M.D.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

036-080194 Issued in IL

Practice address

1025 S 6TH St
Springfield, IL 62703-2403

Phone

(217) 528-7541

NPI assigned

Sep 23, 2006

Last updated

Sep 21, 2020By 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 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

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 1

Specialty

Ophthalmology

Education

Southern Illinois University School of Medicine, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Springfield Clinic, LLPGroup PAC ID 0547166076, 678 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Johns Hospital Hospital, Springfield, IL, CCN 140053

Merit-based Incentive Payment System (MIPS)

Final score

88.83 of 100Reported as apm

Quality

75.65

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: randal.peterson.1@28977.direct.athenahealth.com
• Direct secure messaging: rpeterson@pbmd.intellechartdirect.net

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Springfield Clinic LLP

  • Rural Health Clinic/Center
  • Raymond, IL
  • NPI 1013255942

  Limited Partnership Interest

  CMS ownership
• Springfield Clinic LLP

  • Rural Health Clinic/Center
  • Macomb, IL
  • NPI 1730831157

  Limited Partnership Interest

  CMS ownership
• Springfield Clinic LLP

  dba Springfield Clinic Rural Health Neoga

  • Rural Health Clinic/Center
  • Neoga, IL
  • NPI 1972790889

  Limited Partnership Interest

  CMS ownership
• Springfield Clinic, LLP

  • Rural Health Clinic/Center
  • Lincoln, IL
  • NPI 1518143452

  Limited Partnership Interest

  CMS ownership
• Springfield Clinic, LLP

  • Rural Health Clinic/Center
  • Nokomis, IL
  • NPI 1922285600

  Limited Partnership Interest

  CMS ownership

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.

• Springfield Clinic LLP

  dba Springfield Clinic Ambulatory Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Springfield, IL
  • NPI 1992752224
  Medicare reassignment Care Compare group NPD
• Springfield Clinic, LLP

  • Multi-Specialty Clinic/Center
  • Springfield, IL
  • NPI 1780638478
  Medicare reassignment

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

• St Johns Hospital of the Hospital Sisters of the Third Order of St F

  dba HSHS St. John's Hospital

  • General Acute Care Hospital
  • Springfield, IL
  • NPI 1205818481
  Care Compare affiliation

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

{
    "created_epoch": "1158969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600646400000",
    "number": "1184724866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 CENTRE WEST DR",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627042173",
            "telephone_number": "217-528-7541",
            "fax_number": "217-528-8962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 S 6TH ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627032403",
            "telephone_number": "217-528-7541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "RANDAL",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-23",
        "last_updated": "2020-09-21",
        "certification_date": "2020-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "IL",
            "license": "036-080194",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036080194",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "randalpeterson@sfc.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "1200 CENTRE WEST DR",
            "city": "SPRINGFIELD",
            "state": "IL",
            "country_code": "US",
            "postal_code": "627042173",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Andrea Dawn Peterson, LCSW
• David R Peterson, M.D.
• Devin Peterson, MD
• James Peterson, DDS
• Paige A Peterson
• Tracy L. Peterson, CRNA
• William L. Peterson, M.D.
• Isabella Pethy, RBT
• Isabella M Petitt, RBT
• Isabella Marie Catherine Petrilli, RBT

• Ophthalmology Physician in Springfield, IL
• Providers in Springfield, IL by specialty
• Ophthalmology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; 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.