Individual provider Active NPI

Andrea A Peterson, MD

  • Internal Medicine Physician
  • Norwalk, CT
National Provider Identifier
1245200187
Registry record updated Oct 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
040602 Issued in CT
Practice address
24 Stevens St
Norwalk, CT 06850-3852
Phone
(203) 852-2375
NPI assigned
Jan 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2008

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 40602 CT
Adult Medicine Physician 207QA0505X 040602 CT
Internal Medicine Physician 207R00000X 040602 CT Primary

Addresses

Primary practice location

24 Stevens St
Norwalk, CT 06850-3852

Mailing address

24 Stevens St
Norwalk, CT 06850-3852
Phone (203) 852-2375

Other identifiers 8

IdentifierTypeStateIssuer
OV2706OtherCTHEALTHNET
2254541OtherCTUHC
2991975OtherCTAETNA
010040602CT01OtherCTANTHEM B/C
P2718821OtherCTOXFORD
5565197OtherCTCIGNA
001406025MedicaidCT
40602OtherCTCONNECTICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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

Enrollment IDStateProvider typePAC IDDetails
I20060112000684 CT Practitioner - Internal Medicine 5496778771 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Hartford Healthcare Medical Group Specialists, PLLC CurrentSince Dec 1, 2023 Accepting new patients
Norwalk Hospital Association CurrentSince Jan 1, 2013 Accepting new patients
Norwalk Hospital Association CurrentSince Jan 1, 2013 Accepting new patients
Hartford Healthcare Medical Group Specialists LLC CurrentSince Dec 1, 2023 Accepting new patients

Locations

520 West Ave
Norwalk, CT 06850
Phone (203) 852-2417

1244 Storrs Rd
Storrs Mansfield, CT 06268
Phone (860) 724-2579

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1138060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222819200000",
    "number": "1245200187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 STEVENS ST",
            "city": "NORWALK",
            "state": "CT",
            "postal_code": "068503852",
            "telephone_number": "203-852-2375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 STEVENS ST",
            "city": "NORWALK",
            "state": "CT",
            "postal_code": "068503852",
            "telephone_number": "203-852-2375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "ANDREA",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-24",
        "last_updated": "2008-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "CT",
            "license": "40602",
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "CT",
            "license": "040602",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "040602",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "OV2706",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC",
            "identifier": "2254541",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "2991975",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM B/C",
            "identifier": "010040602CT01",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P2718821",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "5565197",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001406025",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONNECTICARE",
            "identifier": "40602",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Norwalk, CT

Sources for this page

Verify at the official NPI Registry.