Nathan Jeffrey Petersen, MD
Individual provider Active NPI Obstetrics & Gynecology Physician · Glendale, AZ
NPI 1245525930 · NPPES record last updated Nov 2, 2017
Key facts
- NPI
- 1245525930
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- License
- 51043 (AZ)
- Practice address
- 6370 W Union Hills Dr
Glendale, AZ 85308-7136 - Phone
- (623) 414-3500
- Fax
- (623) 455-9214
- NPI assigned
- Jun 10, 2011
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 31
Medicare Care Compare profile
- Specialty
- Obstetrics/Gynecology
- Education
- University of Virginia School of Medicine, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- The Board of Trustees of the University of Illinois
Heartland Community Health Clinic
Practice addresses (Care Compare)
1 Illini Dr
Peoria, IL 61605-2576
Phone (309) 671-3173
1800 N Knoxville Ave
Peoria, IL 61603-3005
Phone (309) 680-7600
19 Olt Ave
Pekin, IL 61554-6214
Phone (309) 680-7600
Hospital & facility affiliations
- Saint Francis Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 93.28 of 100
- Quality
- 73.53
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 70.73
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of the uterus | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190724001937 | IL | Practitioner - Obstetrics/Gynecology | 7113218116 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R72843 | AZ | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Board of Trustees of the University of Illinois | Current |
Accepting new patients | |
| Board of Trustees of the University of Illinois | Current |
Accepting new patients | |
| The Board of Trustees of the University of Illinois | Current | Accepting new patients | |
| Heartland Community Health Clinic | Past | Accepting new patients |
Locations
7694 Solutions Ctr
Chicago, IL 60677
1 Illini Dr
Peoria, IL 61605
Phone (309) 671-3000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | R72843 | AZ | |
| Obstetrics & Gynecology Physician | 207V00000X | 51043 | AZ | Yes |
Addresses
Primary practice location
6370 W Union Hills Dr
Glendale, AZ 85308-7136
Mailing address
6370 W Union Hills Dr
Glendale, AZ 85308-7136
Phone (623) 414-3500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 167288 | Medicaid | AZ |
Other providers in Glendale, AZ
- Eric A Peters
- Krylyn Peters
- Richard Peters
- Sandi Peters
- Kenneth R. Petersen
- Samantha Peterson
- Semas C Peterson
- Wayne Peterson
- Petkov Bodywork Therapy, LLC
- Rumen Antoniev Petkov
All providers in Glendale, AZ · Obstetrics & Gynecology Physician in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 2, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.