Jeffrey E Petersen, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

2001020599 Issued in MO

Practice address

1011 Bowles Ave
Suite 121
Fenton, MO 63026-2395

Phone

(314) 200-2713

Fax

(314) 200-2714

NPI assigned

Jul 17, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in MO

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

Specialty

Dermatology

Education

Indiana University School of Medicine, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St Louis Dermatology LLCGroup PAC ID 7517197247, 6 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

93.85 of 100Reported as individual

Quality

100

Promoting interoperability

100

Improvement activities

40

Cost

79.5

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• St Louis Dermatology LLC

  • Dermatology Physician
  • Fenton, MO
  • NPI 1760810543
  Medicare reassignment Care Compare group Authorized official
• Laser and Skin Surgery Center of Indiana, P.C.

  • Dermatology Physician
  • Indianapolis, IN
  • NPI 1912030966
  NPD (past)
• University Dermatology, Inc.

  • Dermatology Physician
  • Indianapolis, IN
  • NPI 1033159405
  NPD (past)

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406246400000",
    "number": "1275551707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 BOWLES AVE",
            "address_2": "SUITE 121",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630262395",
            "telephone_number": "314-200-2713",
            "fax_number": "314-200-2714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 BOWLES AVE",
            "address_2": "SUITE 121",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630262395",
            "telephone_number": "314-200-2713",
            "fax_number": "314-200-2714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "JEFFREY",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2014-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MO",
            "license": "2001020599",
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "MO",
            "license": "2001020599",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "703212",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MO-BLUE SHIELD",
            "identifier": "146422",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "205401409",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "853972",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "3177332",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rachel Pence
• Gregorius Resuma Penilla, M.D.
• Timothy James Perkins, MSN, FNP-BC
• Clayton R Perry, MD
• Peter J Anderson, MD PC
• Maryellen Petrie, DPT
• Gregory Morris Pfeffer
• Jessica Laura Phillips, FNP
• Physicians Health Group Medical Inc
• Physicians Health Group, LLC

• Dermatology Physician in Fenton, MO
• Providers in Fenton, MO by specialty
• Dermatology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2014; 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.