NPIMap

Individual provider Active NPI

Rebecca Jarratt Petersen, MD

  • Psychiatry Physician
  • Council Bluffs, IA
National Provider Identifier
1306403183
Registry record updated Jun 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
497 Issued in SD
Practice address
800 Mercy Dr
Council Bluffs, IA 51503-3128
Phone
(712) 328-5000
NPI assigned
May 28, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 70776 MN
Psychiatry Physician 2084P0800X 17557 ND
Psychiatry Physician 2084P0800X 497 SD Primary

Addresses

Primary practice location

800 Mercy Dr
Council Bluffs, IA 51503-3128

Mailing address

3124 S Triple Play Ave
Sioux Falls, SD 57110-8811
Phone (605) 941-4947

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, IA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220308000702 MN Practitioner - Psychiatry 6103152756 Reassigns benefits to 4 organizations
I20230802003655 IA Practitioner - Psychiatry 6103152756 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Sanford School of Medicine of University of South Dakota, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Cloud HospitalGroup PAC ID 4880594779, 215 clinicians
Alegent Creighton HealthGroup PAC ID 1850285255, 137 clinicians

Practice addresses (Care Compare)

1406 6TH Ave N
Saint Cloud, MN 56303-1900
Phone (320) 251-2700

801 Harmony St
Suite 302
Council Bluffs, IA 51503-3106
Phone (712) 328-2609

Hospital & facility affiliations

  • CHI Health Mercy Council Bluffs Hospital, Council Bluffs, IA, CCN 160028
  • Centracare - St. Cloud Hospital Hospital, Saint Cloud, MN, CCN 240036

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
70776MNMDPsychiatry Physician
17557NDMDPsychiatry Physician
497SDMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Health System-NR LLC CurrentSince Feb 1, 2022 Accepting new patients
Centracare Health System-NR LLC Current Accepting new patients
St. Cloud Hospital CurrentSince Feb 1, 2022 Accepting new patients
Carris Health LLC Psychiatry CurrentSince Feb 18, 2022 Accepting new patients
Carris Health LLC CurrentSince Feb 18, 2022 Accepting new patients
Alegent Creighton Health Psychiatry CurrentSince Aug 1, 2023 Accepting new patients
Alegent Creighton Health CurrentSince Aug 1, 2023 Accepting new patients
St. Cloud Hospital CurrentSince Feb 1, 2022 Accepting new patients
St. Cloud Hospital Current Accepting new patients
Centracare Health System-NR LLC CurrentSince Feb 1, 2022 Accepting new patients
Alegent Health Bergan Mercy Health System Past Accepting new patients
Alegent Health Bergan Mercy Health System Past Accepting new patients

Locations

801 Harmony St
Ste 302
Council Bluffs, IA 51503
Phone (712) 328-2609

800 Mercy Dr
Council Bluffs, IA 51503
Phone (712) 328-5000

2771 Solution Ctr
Chicago, IL 60677

1013 Hart Blvd
Monticello, MN 55362
Phone (763) 271-2303

1406 6th Ave N
Saint Cloud, MN 56303
Phone (320) 255-5657

110 2nd St S
Ste 104
Waite Park, MN 56387
Phone (320) 259-9375

301 Becker Ave SW
Willmar, MN 56201
Phone (320) 231-4120

7261 Mercy Rd
Omaha, NE 68124
Phone (402) 398-6248

Interoperability endpoints

  • Direct secure messaging: rpetersen614036@direct.centracare.com

Organizations & group practices 17

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.

View all 17

Hospital & facility affiliations 7

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": "1559001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686009600000",
    "number": "1306403183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3124 S TRIPLE PLAY AVE",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571108811",
            "telephone_number": "605-941-4947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 MERCY DR",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515033128",
            "telephone_number": "712-328-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "REBECCA",
        "middle_name": "JARRATT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-28",
        "last_updated": "2023-06-06",
        "certification_date": "2023-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MN",
            "license": "70776",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "ND",
            "license": "17557",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "SD",
            "license": "497",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Council Bluffs, IA

Sources for this page

Verify at the official NPI Registry.