Kimberly Dianne Peterson, LISW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

06171 Issued in IA

Practice address

6601 SW 9TH St
Des Moines, IA 50315-6138

Phone

(515) 643-8350

Fax

(515) 643-5824

NPI assigned

May 24, 2017

Sex

Female

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

Enrolled in IA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Mercy Clinics IncGroup PAC ID 7911810882, 441 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercyone Des Moines Medical Center Hospital, Des Moines, IA, CCN 160083

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 and National Provider Directory roles.

• Mercy Clinics, Inc.

  • Primary Care Clinic/Center
  • Clive, IA
  • NPI 1487670923
  Medicare reassignment Care Compare group NPD
• Mercy Clinics, Inc

  • Psychiatry Physician
  • Des Moines, IA
  • NPI 1457691842

  Clinical

  NPD
• Mercy Clinics, Inc.

  • Obstetrics & Gynecology Physician
  • Des Moines, IA
  • NPI 1508741505
  NPD
• Eyerly Ball Community Mental Health Services

  • Community Health Clinic/Center
  • Des Moines, IA
  • NPI 1598514895
  NPD (past)
• Eyerly Ball Community Mental Health Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Des Moines, IA
  • NPI 1982657490
  NPD (past)

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

• Catholic Health Initiatives - Iowa Corp

  • General Acute Care Hospital
  • West Des Moines, IA
  • NPI 1538395975
  Care Compare affiliation
• Catholic Health Initiatives-Iowa Corp

  • Clinical Medical Laboratory
  • Des Moines, IA
  • NPI 1104982743

  Hospital

  Care Compare affiliation
• Catholic Health Initiatives-Iowa Corp

  • General Acute Care Hospital
  • Des Moines, IA
  • NPI 1508964883
  Care Compare affiliation
• Catholic Health Initiatives, Ia-Corp

  • Mammography Clinic/Center
  • Des Moines, IA
  • NPI 1477984367

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1495584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735257600000",
    "number": "1407384233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1475",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503051475",
            "telephone_number": "515-643-8350",
            "fax_number": "515-643-5824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6601 SW 9TH ST",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503156138",
            "telephone_number": "515-643-8350",
            "fax_number": "515-643-5824"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1525 Grand Ave",
            "address_purpose": "LOCATION",
            "city": "West Des Moines",
            "state": "IA",
            "postal_code": "502653412",
            "country_code": "US",
            "telephone_number": "515-643-8350",
            "fax_number": "515-643-5824",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "800 E 1st St Ste 1700",
            "address_purpose": "LOCATION",
            "city": "Ankeny",
            "state": "IA",
            "postal_code": "500212100",
            "country_code": "US",
            "telephone_number": "515-643-8350",
            "fax_number": "515-643-5824",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1007 S Jefferson Way",
            "address_purpose": "LOCATION",
            "city": "Indianola",
            "state": "IA",
            "postal_code": "501253221",
            "country_code": "US",
            "telephone_number": "515-961-1154",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1301 Center St",
            "address_purpose": "LOCATION",
            "city": "Des Moines",
            "state": "IA",
            "postal_code": "503091004",
            "country_code": "US",
            "telephone_number": "515-241-0982",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "KIMBERLY",
        "middle_name": "DIANNE",
        "credential": "LISW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-24",
        "last_updated": "2024-12-27",
        "certification_date": "2024-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IA",
            "license": "06171",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IA",
            "license": "06171",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1982657490",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Harold Lars Peterson, LMSW
• I Eugene Peterson, M.D.
• Jason R Peterson, R D
• Joseph Steven Peterson, D.O.
• Kathleen S Peterson, RPH
• Rebecca Peterson, LMHC
• Rebecca Peterson
• Shannon E Peterson
• Shelly Ranee Peterson, MA,NMT FELLOW,MT-BC
• Brandon Petree, DO

• Clinical Social Worker in Des Moines, IA
• Providers in Des Moines, IA by specialty
• Clinical Social Worker in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 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.