Mark Peterson, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

A82029 Issued in CA

Practice address

3102 E. Highland Avenue
Medical Staff Office
Patton, CA 92369

Phone

(909) 425-7679

Fax

(909) 425-6635

NPI assigned

Jun 9, 2006

Last updated

Feb 16, 2024By 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

Medicare fee-for-service enrollment

Enrolled in CA

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.

Enrollment records 1

Specialty

Psychiatry

Education

Loma Linda University School of Medicine, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Department of State HospitalsGroup PAC ID 9638174238, 275 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

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.

• Department of State Hospitals

  dba Coalinga State Hospital

  • Psychiatric Hospital
  • Coalinga, CA
  • NPI 1124078704
  Medicare reassignment Care Compare group NPD
• Nebula Health, LLC

  • Adult Mental Health Clinic/Center
  • Riverside, CA
  • NPI 1194479501

  Psychiatry

  Medicare reassignment NPD
• Department of State Hospitals

  dba Department of State Hospitals - Patton

  • Psychiatric Hospital
  • Patton, CA
  • NPI 1043249204
  NPD
• Department of State Hospitals

  dba Department of State Hospitals-Atascadero

  • Psychiatric Hospital
  • Atascadero, CA
  • NPI 1174573802
  NPD
• Nebula Health, P. C.

  • Psychiatry Physician
  • Riverside, CA
  • NPI 1770357147
  NPD (past)

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708041600000",
    "number": "1396786620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3102 E. HIGHLAND AVENUE",
            "address_2": "MEDICAL STAFF OFFICE",
            "city": "PATTON",
            "state": "CA",
            "postal_code": "92369",
            "telephone_number": "909-425-7679",
            "fax_number": "909-425-6635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3102 E. HIGHLAND AVENUE",
            "address_2": "MEDICAL STAFF OFFICE",
            "city": "PATTON",
            "state": "CA",
            "postal_code": "92369",
            "telephone_number": "909-425-7679",
            "fax_number": "909-425-6635"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6833 Indiana Ave Ste 101",
            "address_purpose": "LOCATION",
            "city": "Riverside",
            "state": "CA",
            "postal_code": "925064223",
            "country_code": "US",
            "telephone_number": "657-346-6319",
            "fax_number": "951-269-4184",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-09",
        "last_updated": "2024-02-16",
        "certification_date": "2024-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A82029",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caterina Elisa Pasquali, PHD
• Allison Pate, PHD, ABPP
• Patton State Hospital
• Edwin Peng, M.D.
• Reiner San Diego Perillo, RPT
• Maya Alyce Petties, PSY.D.
• Chinh Duc Pham, M.D.
• Anicia Jimenez Policar, M.D.
• Glenn L Potts, PH.D.
• Rhonda J Powell, LCSW

• Psychiatry Physician in Patton, CA
• Providers in Patton, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.