NPIMap

Individual provider Active NPI

David R Peterson, M.D.

  • Emergency Medicine Physician
  • Springfield, IL
National Provider Identifier
1194742718
Registry record updated Dec 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
036107652 Issued in IL
Practice address
800 E Carpenter St
Springfield, IL 62769-0002
Phone
(217) 544-6464
NPI assigned
Jul 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 036107652 IL Primary

Addresses

Primary practice location

800 E Carpenter St
Springfield, IL 62769-0002

Mailing address

200 Corporate Blvd
Lafayette, LA 70508-3870
Phone (800) 893-9698

Other practice location 1

400 N Caldwell St
Staunton, IL 62088-1173
Phone (618) 635-2200

Other identifiers 1

IdentifierTypeStateIssuer
036107652MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20040205001208 IL Practitioner - Emergency MedicinePractitioner - Internal Medicine 1052204773 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency MedicineAlso: Internal Medicine
Education
Southern Illinois University School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hillsboro Area Hospital, Inc.Group PAC ID 4486547148, shared by 4 NPIs, 37 clinicians

Practice addresses (Care Compare)

1200 E Tremont St
Hillsboro, IL 62049-1912
Phone (217) 532-6111

Hospital & facility affiliations

  • Hillsboro Area Hospital Hospital, Hillsboro, IL, CCN 141332

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Midwest Emergency Anderson Health, Inc Emergency Medicine CurrentSince Feb 1, 2022 Accepting new patients
Pana Community Hospital Association CurrentSince Feb 1, 2022 Accepting new patients
Hillsboro Area Hospital, Inc. Current Accepting new patients
Hillsboro Area Hospital, Inc. CurrentSince Sep 16, 2023 Accepting new patients
Hillsboro Area Hospital, Inc. Emergency Medicine CurrentSince Sep 16, 2023 Accepting new patients
Pana Medical Group CurrentSince Feb 1, 2022 Accepting new patients
Midwest Inpatient Anderson Health, Inc Emergency Medicine CurrentSince Feb 1, 2022 Accepting new patients
Pana Community Hospital Association Current Accepting new patients
Central Illinois Emergency Physicians, LLP Emergency Medicine Past Accepting new patients
Berwyn Emergency Physicians, LLP Emergency Medicine Past Accepting new patients

Locations

1200 E Tremont St
Hillsboro, IL 62049
Phone (217) 532-4154

6800 State Route 162
Maryville, IL 62062
Phone (618) 288-4095

101 E 9th St
Pana, IL 62557
Phone (217) 562-2131

400 N Caldwell St
Staunton, IL 62088
Phone (618) 635-2200

Organizations & group practices 10

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.

Hospital & facility affiliations 2

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": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575590400000",
    "number": "1194742718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 CORPORATE BLVD",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705083870",
            "telephone_number": "800-893-9698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 E CARPENTER ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627690002",
            "telephone_number": "217-544-6464"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 N Caldwell St",
            "address_purpose": "LOCATION",
            "city": "Staunton",
            "state": "IL",
            "postal_code": "620881173",
            "country_code": "US",
            "telephone_number": "618-635-2200",
            "fax_number": "618-635-3400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "DAVID",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2019-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036107652",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036107652",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.