Tara L. Peterson, APRN

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

110711 Issued in NE

Practice address

8901 Indian Hills Dr
Suite 200
Omaha, NE 68114-4057

Phone

(402) 397-7057

Fax

(402) 397-6656

NPI assigned

Mar 17, 2006

Sex

Female

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 2

Medicare fee-for-service enrollment

Enrolled in NE, IA2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Midwest Gastrointestinal Associates PCGroup PAC ID 3779575766, 54 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• The Nebraska Methodist Hospital Hospital, Omaha, NE, CCN 280040
• Methodist Jennie Edmundson Hospital, Council Bluffs, IA, CCN 160047
• CHI Health Lakeside Hospital, Omaha, NE, CCN 280130
• Bellevue Medical Center Hospital, Bellevue, NE, CCN 280132

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Midwest Gastrointestinal Associates PC

  • Gastroenterology Physician
  • Omaha, NE
  • NPI 1073569125

  IA

  Medicare reassignment Care Compare group NPD
• Jennie Edmundson Memorial Hospital

  • Emergency Medicine Physician
  • Council Bluffs, IA
  • NPI 1942251269
  NPD (past)

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

• Alegent Creighton Health

  • General Acute Care Hospital
  • Omaha, NE
  • NPI 1649355132
  Care Compare affiliation
• Bellevue Medical Center LLC

  • General Acute Care Hospital
  • Bellevue, NE
  • NPI 1609007525
  Care Compare affiliation
• Nebraska Methodist Hospital

  • General Acute Care Hospital
  • Omaha, NE
  • NPI 1427147883
  Care Compare affiliation
• Jennie Edmundson Memorial Hospital

  • General Acute Care Hospital
  • Council Bluffs, IA
  • NPI 1457448755
  Care Compare affiliation

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

{
    "created_epoch": "1142553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1260230400000",
    "number": "1235108457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8901 INDIAN HILLS DR",
            "address_2": "SUITE 200",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681144057",
            "telephone_number": "402-397-7057",
            "fax_number": "402-397-6656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8901 INDIAN HILLS DR",
            "address_2": "SUITE 200",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681144057",
            "telephone_number": "402-397-7057",
            "fax_number": "402-397-6656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "TARA",
        "middle_name": "L.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-17",
        "last_updated": "2009-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NE",
            "license": "110711",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47077295213",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025290600",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shatawnee Peterson, LMSW, LMHP, LIMHP
• Stephanie A Peterson, PH.D.
• Susan K Peterson
• Taiven Peterson
• Tammy Peterson
• Taya Peterson
• Tiffany Ann Peterson, PTA
• Vicky Peterson, RN
• Surya Srividya Petla, MD
• Terezia Petraskova, DO

• Gerontology Nurse Practitioner in Omaha, NE
• Providers in Omaha, NE by specialty
• Gerontology Nurse Practitioner in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2009; 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.
• 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.