Chad William Petersen, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

1436 Issued in WY

Practice address

6238 Yellowstone Rd
Cheyenne, WY 82009-3432

Phone

(307) 635-6940

Fax

(307) 635-2839

NPI assigned

Apr 10, 2013

Last updated

Dec 12, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Sep 15, 2017 through Sep 15, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Cheyenne Oral & Maxillofacial Surgery Associates, L.L.C

  • Oral and Maxillofacial Surgery Clinic/Center
  • Cheyenne, WY
  • NPI 1306046651
  NPD (past)

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

{
    "created_epoch": "1365552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607731200000",
    "number": "1336582212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6238 YELLOWSTONE RD",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820093432",
            "telephone_number": "307-635-6940",
            "fax_number": "307-635-2839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6238 YELLOWSTONE RD",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820093432",
            "telephone_number": "307-635-6940",
            "fax_number": "307-635-2839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "CHAD",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-10",
        "last_updated": "2020-12-12",
        "certification_date": "2020-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WY",
            "license": "1436",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "145967800",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gregory Peters
• James Warner Peters, MA LPC
• Katie Ann Peters
• Leslie Michelle Peters
• Michael Peters, MD
• Lacey K Petersen, LCSW
• Amy Kathleen Peterson, M.S., CCC-SLP
• Barry Peterson, CSW
• Jacqueline Alyse Peterson, MSW, LCSW
• Mary J Peterson, RT

• Oral and Maxillofacial Surgery (Dentist) in Cheyenne, WY
• Providers in Cheyenne, WY by specialty
• Oral and Maxillofacial Surgery (Dentist) in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.