NPIMap

Individual provider Active NPI

Robert A Peterson II, P.A.-C

  • Medical Physician Assistant
  • Colorado Springs, CO
National Provider Identifier
1285862367
Registry record updated Jul 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
CO3454 Issued in CO
Practice address
4110 Briargate Pkwy
Suite 300
Colorado Springs, CO 80920-7835
Phone
(719) 632-7669
Fax
(719) 632-0088
NPI assigned
Jun 26, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 30, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X CO3454 CO Primary

Addresses

Primary practice location

4110 Briargate Pkwy
Suite 300
Colorado Springs, CO 80920-7835

Mailing address

4110 Briargate Pkwy
Suite 300
Colorado Springs, CO 80920-7835
Phone (719) 632-7669

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
I20120815000760 CO Practitioner - Physician Assistant 3870749310 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Select Physical Therapy of Colorado Springs LPGroup PAC ID 3971498197, shared by 2 NPIs, 84 clinicians

Practice addresses (Care Compare)

1259 Lake Plaza Dr
Suite 100
Colorado Springs, CO 80906-3542
Phone (719) 632-7669

4110 Briargate Pkwy
Suite 300
Colorado Springs, CO 80920-7837
Phone (719) 632-7669

5825 Delmonico Dr
Suite 100
Colorado Springs, CO 80919-2243
Phone (719) 257-4240

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.06 of 100Reported as group
Quality
70.6
Promoting interoperability
99
Improvement activities
40
Cost
73.76

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
CO3454COMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Colorado Springs Orthopaedic Group CurrentSince Jun 21, 2012 Accepting new patients
Colorado Springs Orthopaedic Group CurrentSince Jun 21, 2012 Accepting new patients
Colorado Springs Orthopaedic Group Past Accepting new patients

Locations

1259 Lake Plaza Dr
Ste 100
Colorado Springs, CO 80906
Phone (719) 867-7335

4110 Briargate Pkwy
Ste 300
Colorado Springs, CO 80920
Phone (719) 867-7329

1655 Quail Lake Loop
Colorado Springs, CO 80906
Phone (719) 417-4931

Interoperability endpoints

  • Direct secure messaging: rpeterson@csog.emadirect.md

Organizations & group practices 3

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 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1245974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722297600000",
    "number": "1285862367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4110 BRIARGATE PKWY",
            "address_2": "SUITE 300",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809207835",
            "telephone_number": "719-632-7669",
            "fax_number": "719-632-0088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4110 BRIARGATE PKWY",
            "address_2": "SUITE 300",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809207835",
            "telephone_number": "719-632-7669",
            "fax_number": "719-632-0088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON II",
        "first_name": "ROBERT",
        "middle_name": "A",
        "credential": "P.A.-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-06-26",
        "last_updated": "2024-07-30",
        "certification_date": "2024-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CO",
            "license": "CO3454",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.