Dane M Peterson, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

3325 Issued in MN

Practice address

2601 39TH Ave NE Ste 1
St. Anthony, MN 55421-4372

Phone

(763) 416-7600

Fax

(763) 416-7634

NPI assigned

Jul 8, 2009

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

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

University of Missouri St Louis - School of Optometry, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northwest Eye Clinic LLCGroup PAC ID 2163315045, 17 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

83.82 of 100Reported as group

Quality

80.89

Promoting interoperability

94

Improvement activities

40

Cost

70.18

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Northwest Eye Clinic, LLC

  • Ophthalmology Physician
  • Golden Valley, MN
  • NPI 1497837306

  MN

  Medicare reassignment Care Compare group NPD (past)
• Northwest Eye Clinic, LLC

  • Ophthalmology Physician
  • St. Anthony, MN
  • NPI 1255417002
  NPD

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

{
    "created_epoch": "1247011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584403200000",
    "number": "1285863530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8401 GOLDEN VALLEY RD STE 330",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554274488",
            "telephone_number": "763-416-7629",
            "fax_number": "763-383-4147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 39TH AVE NE STE 1",
            "city": "ST. ANTHONY",
            "state": "MN",
            "postal_code": "554214372",
            "telephone_number": "763-416-7600",
            "fax_number": "763-416-7634"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12000 Elm Creek Blvd N Ste 100",
            "address_purpose": "LOCATION",
            "city": "Maple Grove",
            "state": "MN",
            "postal_code": "553697074",
            "country_code": "US",
            "telephone_number": "763-416-7600",
            "fax_number": "763-416-7634",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8501 Golden Valley Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Golden Valley",
            "state": "MN",
            "postal_code": "554274472",
            "country_code": "US",
            "telephone_number": "763-416-7600",
            "fax_number": "763-416-7634",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "DANE",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-08",
        "last_updated": "2020-03-17",
        "certification_date": "2020-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CO",
            "license": "2738",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3325",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Our Future Inc.
• Partners Home Care
• Pathwaycare Transportation Inc
• Jennifer Pearson, CD(DONA)
• Katherine Perez
• Eric Peterson, MA, LPCC, LADC
• Roxanee E Pierre, MD
• Andrea Jo Pitzl, PA-C
• Allyson Plumberg, M.S.CCC-SLP
• Premier Health Homes Inc

• All providers in St. Anthony, MN
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2020; 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.