NPIMap

Individual provider Active NPI

Carol Joan Peitzman, APRN, CNS

  • Adult Psychiatric/Mental Health Clinical Nurse Specialist
  • Faribault, MN
National Provider Identifier
1225120991
Registry record updated Jan 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Psychiatric/Mental Health Clinical Nurse SpecialistTaxonomy code 364SP0809X
License
240 Issued in MN
Practice address
400 4TH St NW
Faribault, MN 55021-5089
Phone
(507) 384-6830
NPI assigned
Sep 29, 2006
Last updated
Jan 10, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Psychiatric/Mental Health Clinical Nurse Specialist 364SP0809X 240 MN Primary

Addresses

Primary practice location

400 4TH St NW
Faribault, MN 55021-5089

Mailing address

3200 Labore Rd Ste 104
Vadnais Heights, MN 55110-5186

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20050119000754 MN Practitioner - Certified Clinical Nurse Specialist (CNS) 9830148642 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Clinical Nurse Specialist (CNS)
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Southern Cities ClinicGroup PAC ID 7517912991, 6 clinicians

Practice addresses (Care Compare)

400 4TH St NW
Faribault, MN 55021-5031
Phone (507) 384-6830

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Specialist

State licenses

LicenseStateTypeSpecialty
240MNMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Health Counseling Services Past Accepting new patients
Open Cities Health Center, Inc. Past Accepting new patients
Quality Care Clinic Past Accepting new patients
Southern Cities Community Clinic PastSince Feb 13, 2017 Accepting new patients

Organizations & group practices 5

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.

Hospital & facility affiliations 9

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": "1159488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736467200000",
    "number": "1225120991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 LABORE RD STE 104",
            "city": "VADNAIS HEIGHTS",
            "state": "MN",
            "postal_code": "551105186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 4TH ST NW",
            "city": "FARIBAULT",
            "state": "MN",
            "postal_code": "550215089",
            "telephone_number": "507-384-6830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEITZMAN",
        "first_name": "CAROL",
        "middle_name": "JOAN",
        "credential": "APRN, CNS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-29",
        "last_updated": "2025-01-10",
        "certification_date": "2025-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SP0809X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health, Adult",
            "state": "MN",
            "license": "240",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Faribault, MN

Sources for this page

Verify at the official NPI Registry.