Individual provider Active NPI

Eric Julian Peterson, CRNA,MSN

  • Certified Registered Nurse Anesthetist
  • Willmar, MN
National Provider Identifier
1265436059
Registry record updated Mar 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
53163, R131880-1 Issued in MN
Practice address
301 Becker Ave SW
Willmar, MN 56201-3302
Phone
(320) 231-4120
NPI assigned
Jun 9, 2005
Last updated
Mar 29, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 53163, R131880-1 MN Primary

Addresses

Primary practice location

301 Becker Ave SW
Willmar, MN 56201-3302

Mailing address

1011 15TH Ave NW
Willmar, MN 56201-2138
Phone (320) 214-1222

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address epeterson29800@direct.centracare.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040514000754 MN Practitioner - Certified Registered Nurse Anesthetist (Crna) 0244220952 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centracare Clinic Southwest LLCGroup PAC ID 8426457946, 172 clinicians

Practice addresses (Care Compare)

600 Peterson Pkwy
New London, MN 56273-7823
Phone (320) 354-2222

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse, Master of Science - Nursing

State licenses

LicenseStateTypeSpecialty
53163, R131880-1MNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
CCM Health CurrentSince Dec 11, 2023 Accepting new patients
Centracare Clinic Southwest LLC CurrentSince Nov 1, 2021 Accepting new patients
Minnesota Pathologists Chartered Current Accepting new patients
Centracare Clinic Southwest LLC CurrentSince Nov 1, 2021 Accepting new patients
CCM Health CurrentSince Dec 11, 2023 Accepting new patients

Locations

824 N 11th St
Montevideo, MN 56265
Phone (320) 269-8877

600 Peterson Pkwy
New London, MN 56273
Phone (320) 354-2222

1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342

1406 6th Ave N
Saint Cloud, MN 56303
Phone (320) 255-5657

301 Becker Ave SW
Willmar, MN 56201
Phone (320) 231-4120

101 Willmar Ave SW
Willmar, MN 56201
Phone (320) 231-5079

Interoperability endpoints

  • Direct secure messaging: epeterson29800@direct.centracare.com

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 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": "1118275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680048000000",
    "number": "1265436059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 15TH AVE NW",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562012138",
            "telephone_number": "320-214-1222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 BECKER AVE SW",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562013302",
            "telephone_number": "320-231-4120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "ERIC",
        "middle_name": "JULIAN",
        "credential": "CRNA,MSN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-09",
        "last_updated": "2023-03-29",
        "certification_date": "2023-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MN",
            "license": "53163,  R131880-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "epeterson29800@direct.centracare.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "epeterson29800@direct.centracare.com",
            "address_1": "301 Becker Ave SW",
            "city": "Willmar",
            "state": "MN",
            "country_code": "US",
            "postal_code": "562013302",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Willmar, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.