James Peterson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019029045 Issued in IL

Practice address

2501 W Iles Ave Ste a
Springfield, IL 62704-6482

Phone

(217) 452-3057

NPI assigned

Jun 15, 2012

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Peterson Dental Care LLC

  • Dental Clinic/Center
  • Springfield, IL
  • NPI 1316430952
  NPD Authorized official

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

{
    "created_epoch": "1339718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741046400000",
    "number": "1376806224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2501 W ILES AVE STE A",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627046482",
            "telephone_number": "217-452-3057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 W ILES AVE STE A",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627046482",
            "telephone_number": "217-452-3057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JAMES",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-15",
        "last_updated": "2025-03-04",
        "certification_date": "2025-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "IL",
            "license": "019029045",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019029045",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ILLINOIS LICENSE NUMBER",
            "identifier": "019029045",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan Elizabeth Peters, RBT
• Peterson Dental Care LLC
• Andrea Dawn Peterson, LCSW
• David R Peterson, M.D.
• Devin Peterson, MD
• Paige A Peterson
• Randal J. Peterson, M.D.
• Tracy L. Peterson, CRNA
• William L. Peterson, M.D.
• Isabella Pethy, RBT

• General Practice Dentistry in Springfield, IL
• Providers in Springfield, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2025; 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.