NPIMap

Individual provider Active NPI

Timothy M Peterson, MD

  • Surgery Physician
  • Litchfield, MN
National Provider Identifier
1306055355
Registry record updated Apr 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
R6912 Issued in IA
Practice address
520 South Sibley Ave
Affiliated Community Medical Centers
Litchfield, MN 55355
Phone
(320) 693-3233
Fax
(319) 384-6004
NPI assigned
May 22, 2007
Last updated
Apr 19, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X R6912 IA Primary

Addresses

Primary practice location

520 South Sibley Ave
Affiliated Community Medical Centers
Litchfield, MN 55355

Mailing address

520 South Sibley Ave
Affiliated Community Medical Centers
Litchfield, MN 55355
Phone (320) 693-3233

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20070726000205 MN Practitioner - General Surgery 9436250099 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Minnesota Medical School, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
County of MeekerGroup PAC ID 0840109740, shared by 4 NPIs, 44 clinicians

Practice addresses (Care Compare)

612 S Sibley Ave
Litchfield, MN 55355-3340
Phone (320) 693-3233

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
R6912IAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
County of Meeker CurrentSince Feb 1, 2020 Accepting new patients
Centracare Health-Paynesville LLC CurrentSince Dec 1, 2022 Accepting new patients
Centracare Health-Paynesville LLC CurrentSince Dec 1, 2022 Accepting new patients
County of Meeker CurrentSince Feb 1, 2020 Accepting new patients
County of Meeker Current Accepting new patients
Centracare Health-Paynesville LLC Current Accepting new patients
County of Meeker Past Accepting new patients

Locations

520 S Sibley Ave
Litchfield, MN 55355
Phone (320) 693-3233

611 S Sibley Ave
Litchfield, MN 55355
Phone (320) 693-2804

612 S Sibley Ave
Litchfield, MN 55355
Phone (320) 693-3242

200 W 1st St
Paynesville, MN 56362
Phone (320) 243-3767

Interoperability endpoints

  • Direct secure messaging: tpeterson29803@direct.centracare.com

Organizations & group practices 7

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 3

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": "1179792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1303171200000",
    "number": "1306055355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 SOUTH SIBLEY AVE",
            "address_2": "AFFILIATED COMMUNITY MEDICAL CENTERS",
            "city": "LITCHFIELD",
            "state": "MN",
            "postal_code": "55355",
            "telephone_number": "320-693-3233",
            "fax_number": "319-384-6004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 SOUTH SIBLEY AVE",
            "address_2": "AFFILIATED COMMUNITY MEDICAL CENTERS",
            "city": "LITCHFIELD",
            "state": "MN",
            "postal_code": "55355",
            "telephone_number": "320-693-3233",
            "fax_number": "319-384-6004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "TIMOTHY",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-22",
        "last_updated": "2011-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IA",
            "license": "R6912",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Litchfield, MN

Sources for this page

Verify at the official NPI Registry.