Theresa Marie Peter, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601009931 Issued in MI

Practice address

190 E State St
Montrose, MI 48457-9144

Phone

(810) 639-2056

NPI assigned

May 29, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: theresa.pickell.1@15405.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/15403/brand/1/csg/1/fhir/r4

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.

• Mt Morris Medical Group PLLC

  • Internal Medicine Physician
  • Mount Morris, MI
  • NPI 1023389244

  MI

  Medicare reassignment
• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  MI

  Medicare reassignment
• Lapeer Community Urgent Care PLLC

  • Urgent Care Clinic/Center
  • Lapeer, MI
  • NPI 1336536655
  NPD (past)

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

{
    "created_epoch": "1590710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709337600000",
    "number": "1306460076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 E STATE ST",
            "city": "MONTROSE",
            "state": "MI",
            "postal_code": "484579144",
            "telephone_number": "810-639-2056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 E STATE ST",
            "city": "MONTROSE",
            "state": "MI",
            "postal_code": "484579144",
            "telephone_number": "810-639-2056"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "401 S Ballenger Hwy",
            "address_purpose": "LOCATION",
            "city": "Flint",
            "state": "MI",
            "postal_code": "485323638",
            "country_code": "US",
            "telephone_number": "810-342-2000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8434 N Saginaw Rd",
            "address_purpose": "LOCATION",
            "city": "Mount Morris",
            "state": "MI",
            "postal_code": "484581190",
            "country_code": "US",
            "telephone_number": "810-686-1997",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1227 Summit St",
            "address_purpose": "LOCATION",
            "city": "Lapeer",
            "state": "MI",
            "postal_code": "484463919",
            "country_code": "US",
            "telephone_number": "810-969-4546",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETER",
        "first_name": "THERESA",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-29",
        "last_updated": "2024-03-02",
        "certification_date": "2024-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601009931",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Montrose After Hours Clinic PLLC
• Montrose Family Medicine Associates PC
• Jessica Nolan, MSN, APRN, FNP-C
• Breanna Owen, CSFA
• Jennifer Peel, LMSW
• Jamie Eugene Pierson, FNP-BC
• Haley Emily Pinkerman, COTA/L
• Aimee M Reed, PTA
• Robin C Ballard DDS PC
• Tanya M Rowe

• All providers in Montrose, MI
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.