Andrew Petersen, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

11969 Issued in MN

Practice address

1025 Marsh St
Mankato, MN 56001

Phone

(507) 625-4031

NPI assigned

Aug 15, 2014

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

Electronic endpoints 1

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: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: apetersen90610@ehrdirect.mayoclinicmsg.org

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.

• Mayo Clinic Health System-Fairmont

  • Multi-Specialty Clinic/Center
  • Fairmont, MN
  • NPI 1366410862
  Medicare reassignment NPD
• Mayo Clinic Health System-Lake City

  • Multi-Specialty Clinic/Center
  • Lake City, MN
  • NPI 1164463659
  Medicare reassignment NPD
• Mayo Clinic Health System-Southeast Minnesota Region

  • Critical Access Hospital
  • Cannon Falls, MN
  • NPI 1063435410
  Medicare reassignment NPD
• Mayo Clinic Health System-Southeast Minnesota Region

  • Multi-Specialty Clinic/Center
  • Albert Lea, MN
  • NPI 1891701637
  Medicare reassignment NPD
• Mayo Clinic Health System-Southwest Minnesota Region

  • Critical Access Hospital
  • New Prague, MN
  • NPI 1124035282
  Medicare reassignment NPD
• Mayo Clinic Health System-Southwest Minnesota Region

  • Multi-Specialty Clinic/Center
  • Mankato, MN
  • NPI 1578545422
  Medicare reassignment NPD
• Mayo Clinic Health System-Southwest Minnesota Region

  • Critical Access Hospital
  • Waseca, MN
  • NPI 1740256668
  Medicare reassignment NPD
• Mayo Clinic Health System-St James

  • Critical Access Hospital
  • Saint James, MN
  • NPI 1639198732
  Medicare reassignment NPD
• Mayo Clinic Health System-Lake City

  • Critical Access Hospital
  • Lake City, MN
  • NPI 1538113022
  Medicare reassignment
• Mayo Clinic Health System-St James

  • Multi-Specialty Clinic/Center
  • Saint James, MN
  • NPI 1023177730
  Medicare reassignment
• Mayo Clinic Health System-Southeast Minnesota Region

  • Clinic Pharmacy
  • Cannon Falls, MN
  • NPI 1699597468
  NPD
• Mayo Clinic Health System-Southwest Minnesota Region

  • Multi-Specialty Clinic/Center
  • Waseca, MN
  • NPI 1518494251
  NPD

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

{
    "created_epoch": "1408060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600387200000",
    "number": "1316346307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 MARSH ST",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560014752",
            "telephone_number": "507-625-4031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 MARSH ST",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "56001",
            "telephone_number": "507-625-4031"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "700 E University Ave",
            "address_purpose": "LOCATION",
            "city": "Des Moines",
            "state": "IA",
            "postal_code": "503162302",
            "country_code": "US",
            "telephone_number": "515-263-5120",
            "fax_number": "515-263-5164",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "ANDREW",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-08-15",
        "last_updated": "2020-09-18",
        "certification_date": "2020-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "074607",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "11969",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "apetersen90610@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "1025 Marsh St",
            "city": "Mankato",
            "state": "MN",
            "country_code": "US",
            "postal_code": "56001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Matthew Jerome Perrault, DC
• Matthew Joseph Perri, DNP, APRN, FNP-C
• Earle Peters
• Scott B. Peters, D.D.S., M.S.
• Amy Petersen, CNM, DNP
• Anna Petersen
• Danielle Marie Petersen, RN
• Mary Jane Petersen, PT
• Sarah Rose Petersen
• Alex D. Peterson, FNP-C

• Physician Assistant in Mankato, MN
• Providers in Mankato, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.