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Individual provider Active NPI

Andria Jo Petersen, NP-C

  • Psychiatric/Mental Health Nurse Practitioner
  • Sioux Falls, SD
National Provider Identifier
1194280156
Registry record updated Jun 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
CP001529 Issued in SD
Practice address
2400 W 49TH St
Sioux Falls, SD 57105-6581
Phone
(605) 312-8700
Fax
(605) 312-8700
NPI assigned
Feb 4, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X CP001529 SD
Psychiatric/Mental Health Nurse Practitioner 363LP0808X CP001529 SD Primary

Addresses

Primary practice location

2400 W 49TH St
Sioux Falls, SD 57105-6581

Mailing address

2400 W 49TH St
Sioux Falls, SD 57105-6581
Phone (605) 312-8700

Other names 1

  • Andria Jo Homan Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190312001039 SD Practitioner - Nurse Practitioner 8426397308 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sanford Medical CenterGroup PAC ID 8325950215, 847 clinicians

Practice addresses (Care Compare)

1301 W 18TH St
Sioux Falls, SD 57105-0401
Phone (605) 312-2200

1305 W 18TH St
Sioux Falls, SD 57105-0401
Phone (605) 312-7300

2400 W 49TH St
Sioux Falls, SD 57105-6581
Phone (605) 312-8700

4405 E 26TH St
Sioux Falls, SD 57103-4187
Phone (605) 332-2883

Hospital & facility affiliations

  • Sanford Usd Medical Center Hospital, Sioux Falls, SD, CCN 430027

Merit-based Incentive Payment System (MIPS)

Final score
83.32 of 100Reported as group
Quality
75.87
Promoting interoperability
100
Improvement activities
40
Cost
68.53

Merit-based Incentive Payment System (MIPS)

Final score
84.78 of 100Reported as group
Quality
78.77
Promoting interoperability
100
Improvement activities
40
Cost
70.49

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
CP001529SDMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Clinic CurrentSince Mar 11, 2019 Accepting new patients
Sanford Clinic Nurse Practitioner Current Accepting new patients
Sanford Medical Center Nurse Practitioner CurrentSince Nov 18, 2019 Accepting new patients
Sanford Medical Center CurrentSince Nov 18, 2019 Accepting new patients

Locations

525 N Foster St
Mitchell, SD 57301
Phone (605) 995-2000

4405 E 26th St
Sioux Falls, SD 57103
Phone (605) 328-9000

2400 W 49th St
Sioux Falls, SD 57105
Phone (605) 312-8700

1305 W 18th St
Sioux Falls, SD 57105
Phone (605) 312-7300

Organizations & group practices 16

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.

View all 16

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1549238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560124800000",
    "number": "1194280156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 W 49TH ST",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571056581",
            "telephone_number": "605-312-8700",
            "fax_number": "605-312-8700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 W 49TH ST",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571056581",
            "telephone_number": "605-312-8700",
            "fax_number": "605-312-8700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "ANDRIA",
        "middle_name": "JO",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-04",
        "last_updated": "2019-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SD",
            "license": "CP001529",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "SD",
            "license": "CP001529",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANDRIA",
            "last_name": "HOMAN",
            "middle_name": "JO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Sioux Falls, SD

Sources for this page

Verify at the official NPI Registry.