NPIMap

Individual provider Active NPI

Kevin Thomas Petersen, D.O.

  • Surgery Physician
  • Pensacola, FL
National Provider Identifier
1356778419
Registry record updated Jul 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
DO3578 Issued in NV
Practice address
220 Hovey Rd FL 32508
Pensacola, FL 32508-1044
Phone
(850) 452-9484
NPI assigned
Oct 3, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X DO3578 NV Primary
Surgery Physician 208600000X 294233 NY

Addresses

Primary practice location

220 Hovey Rd FL 32508
Pensacola, FL 32508-1044

Mailing address

220 Hovey Rd FL 32508
Pensacola, FL 32508-1044

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240821001320 NV Practitioner - General Surgery 8426389495 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Unlv MedicineGroup PAC ID 4183991458, 177 clinicians

Practice addresses (Care Compare)

1707 W Charleston Blvd
Suite 160
Las Vegas, NV 89102-2354
Phone (702) 671-5150

Hospital & facility affiliations

  • University Medical Center Hospital, Las Vegas, NV, CCN 290007
  • Los Angeles General Medical Center Hospital, Los Angeles, CA, CCN 050373

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DO3578NVMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Unlv Medicine CurrentSince Jul 24, 2024 Accepting new patients
Unlv Medicine CurrentSince Jul 24, 2024 Accepting new patients
Unlv Medicine Current Accepting new patients
University Medical Center of Southern Nevada Past Accepting new patients

Locations

1707 W Charleston Blvd
Ste 160
Las Vegas, NV 89102
Phone (702) 671-2201

1707 W Charleston Blvd
Ste 110
Las Vegas, NV 89102
Phone (702) 671-2300

1708 W Charleston Blvd Ste 160
Las Vegas, NV 89102

2724 N Tenaya Way
Fl 2
Las Vegas, NV 89128
Phone (702) 939-8557

1800 W Charleston Blvd
Las Vegas, NV 89102
Phone (702) 207-8253

3016 W Charleston Blvd
Ste 100
Las Vegas, NV 89102
Phone (702) 780-2315

Organizations & group practices 4

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.

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1380758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753833600000",
    "number": "1356778419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 HOVEY RD FL 32508",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325081044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 HOVEY RD FL 32508",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325081044",
            "telephone_number": "850-452-9484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "KEVIN",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-10-03",
        "last_updated": "2025-07-30",
        "certification_date": "2025-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NV",
            "license": "DO3578",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NY",
            "license": "294233",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pensacola, FL

Sources for this page

Verify at the official NPI Registry.