NPIMap

Individual provider Active NPI

Debra Jean Petersen, NP

  • Adult Health Nurse Practitioner
  • Broomfield, CO
National Provider Identifier
1265951925
Registry record updated Sep 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
APN.0993074-NP Issued in CO
Practice address
11820 Destination Dr
Broomfield, CO 80021-2518
Phone
(720) 848-0000
NPI assigned
Sep 13, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X APN.0993074-NP CO
Primary Care Nurse Practitioner 363LP2300X APN.0993074-NP CO
Adult Health Nurse Practitioner 363LA2200X APN.0993074-NP CO Primary

Addresses

Primary practice location

11820 Destination Dr
Broomfield, CO 80021-2518

Mailing address

P.O. Box 17528
Denver, CO 80217-7528
Phone (303) 306-7783

Other practice location 1

499 E Hampden Ave Ste 360
Englewood, CO 80113-3877
Phone (303) 781-4485

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20171108000135 CO Practitioner - Nurse Practitioner 0244338572 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Physicians IncorporatedGroup PAC ID 3476465667, 3,189 clinicians

Practice addresses (Care Compare)

12605 E 16TH Ave
Uchealth Anschutz Medical Campus
Aurora, CO 80045-2545
Phone (720) 848-0000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APN.0993074-NPCOMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University Physicians Incorporated CurrentSince Jul 1, 2021 Accepting new patients
University Physicians Incorporated Physical Medicine & Rehabilitation Current Accepting new patients
University Physicians, Incorporated CurrentSince Jul 1, 2021 Accepting new patients
University Physicians, Incorporated Past Accepting new patients

Locations

13123 E 16th Ave
Aurora, CO 80045
Phone (720) 777-3846

12605 E 16th Ave
Aurora, CO 80045
Phone (720) 848-0006

5495 Arapahoe Ave
Fl 2
Boulder, CO 80303
Phone (720) 848-9200

11820 Destination Dr
Broomfield, CO 80021
Phone (303) 460-6000

11820 Destination Dr
Ste 3102
Broomfield, CO 80021

Dept 1061
Denver, CO 80256

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.

Hospital & facility affiliations 31

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

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1505260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630627200000",
    "number": "1265951925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 17528",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802177528",
            "telephone_number": "303-306-7783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11820 DESTINATION DR",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800212518",
            "telephone_number": "720-848-0000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "499 E Hampden Ave Ste 360",
            "address_purpose": "LOCATION",
            "city": "Englewood",
            "state": "CO",
            "postal_code": "801133877",
            "country_code": "US",
            "telephone_number": "303-781-4485",
            "fax_number": "720-274-0064",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "DEBRA",
        "middle_name": "JEAN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-13",
        "last_updated": "2021-09-03",
        "certification_date": "2021-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CO",
            "license": "APN.0993074-NP",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "CO",
            "license": "APN.0993074-NP",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CO",
            "license": "APN.0993074-NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Broomfield, CO

Sources for this page

Verify at the official NPI Registry.