Todd Charles Peterson, D.O.
Individual provider Active NPI Adult Reconstructive Orthopaedic Surgery Physician · Clive, IA
NPI 1407085103 · NPPES record last updated Aug 7, 2015
Key facts
- NPI
- 1407085103
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Adult Reconstructive Orthopaedic Surgery Physician 207XS0114X
- License
- DO-04737 (IA)
- Practice address
- 12499 University Ave
Clive, IA 50325-8288 - Phone
- (515) 440-2676
- NPI assigned
- Jul 2, 2009
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 12
Hospital & facility affiliations 7
Medicare Care Compare profile
- Specialty
- Orthopedic Surgery
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Knoxville Community Hospital Inc
Capital Orthopaedics and Sports Medicine PC
Broadlawns Medical Center
Practice addresses (Care Compare)
1202 W Howard St
Knoxville, IA 50138-3103
Phone (641) 828-7211
12499 University Ave
Suite 210
Clive, IA 50325-8288
Phone (515) 440-2676
1801 Hickman Rd
Des Moines, IA 50314-1548
Phone (515) 282-2200
Hospital & facility affiliations
- Knoxville Hospital & Clinics
- Broadlawns Medical Center
- Boone County Hospital
- Dallas County Hospital
- Mercyone Newton Medical Center
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Hip replacement | 15 |
| Knee replacement | 42 |
| Lower limb (leg) arthroscopy (minimally invasive joint repair) | 1-10 |
| Upper limb (arm) arthroscopy (minimally invasive joint repair) | 16 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151005001841 | IA | Practitioner - Orthopedic Surgery | 0547585671 | Reassigns benefits to 7 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5101018316 | MI | MD | Orthopaedic Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Broadlawns Medical Center | Current |
Accepting new patients | |
| Knoxville Community Hospital Inc | Current | Accepting new patients | |
| Knoxville Community Hospital Inc | Current | Accepting new patients | |
| Boone County Hospital | Current | Accepting new patients | |
| Boone County Comprehensive Specialty Care | Orthopaedic Surgery | Current |
Accepting new patients |
| Knoxville Community Hospital Inc | Current |
Accepting new patients | |
| Capital Orthopaedics and Sports Medicine PC | Orthopaedic Surgery | Current |
Accepting new patients |
| Broadlawns Medical Center | Current |
Accepting new patients | |
| Floyd County Memorial Hospital Commission | Past | Accepting new patients |
Locations
1015 Union St
Ste 120
Boone, IA 50036
Phone (512) 432-7766
1015 Union St
Ste 119
Boone, IA 50036
Phone (515) 433-8500
1015 Union St
Boone, IA 50036
Phone (515) 432-3140
1801 Hickman Rd
Bldg First
Des Moines, IA 50314
12499 University Ave
Ste 210
Des Moines, IA 50325
Phone (515) 240-2676
1801 Hickman Rd
Des Moines, IA 50314
Phone (515) 282-2200
1002 S Lincoln St
Knoxville, IA 50138
Phone (641) 842-1464
1202 W Howard St
Knoxville, IA 50138
Phone (641) 828-7144
610 10th St
Perry, IA 50220
Phone (515) 465-3547
Interoperability endpoints
- https://api.platform.athenahealth.com/19659/brand/1/csg/1/fhir/r4
- todd.peterson.1@19659.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | 5101018316 | MI | |
| Adult Reconstructive Orthopaedic Surgery Physician | 207XS0114X | DO-04737 | IA | Yes |
Addresses
Primary practice location
12499 University Ave
Clive, IA 50325-8288
Mailing address
12411 Lincoln Ave
Clive, IA 50325-8126
Phone (515) 440-2676
Other providers in Clive, IA
- Douglas Pepper
- Adreanne Perkins
- Peter Cade Counseling, PC
- Chad Allen Peters
- Ellen Petersen
- Karman A Pflughaupt
- Kelly Jo Pfundheller
- Janalyn Phillips
- Phippsburger Inc
- PHS Walnut Ridge LLC
All providers in Clive, IA · Adult Reconstructive Orthopaedic Surgery Physician in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 7, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.