Lauren Chandra Peterson

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Practice address

10400 Fricot City Rd
San Andreas, CA 95249-9642

Phone

(209) 736-4500

NPI assigned

Mar 19, 2024

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Rite of Passage Adolescent Treatment Centers and Schools Inc.

  • Adolescent and Children Mental Health Clinic/Center
  • San Andreas, CA
  • NPI 1376003277
  NPD (past)

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

{
    "created_epoch": "1710806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710806400000",
    "number": "1336909407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10400 FRICOT CITY RD",
            "city": "SAN ANDREAS",
            "state": "CA",
            "postal_code": "952499642",
            "telephone_number": "209-736-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10400 FRICOT CITY RD",
            "city": "SAN ANDREAS",
            "state": "CA",
            "postal_code": "952499642",
            "telephone_number": "209-736-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "LAUREN",
        "middle_name": "CHANDRA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-19",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jill Ortiz, RPH
• Frederick Michael Osborne, M.D.
• Neal Parrish
• Shane Michael Patterson, M.D.
• Karen Pekarcik, LCSW 80071
• Gabriel R Pettersen, MD
• Chris Pettinichio
• Thanh Duc Pham, D.D.S.
• Miguel Picasso
• Tandis Kaye Pourbastani

• Community Health Worker in San Andreas, CA
• Providers in San Andreas, CA by specialty
• Community Health Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.