Carlotta Petersen, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA00598 Issued in TX

Practice address

500 W Main St Ste 200
Lewisville, TX 75057-3639

Phone

(877) 314-8990

NPI assigned

Jan 22, 2010

Last updated

Jan 6, 2022By the provider in NPPES

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Elite Orthopaedics of Irving PLLCGroup PAC ID 3779667092, 57 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Medical City Alliance Hospital, Fort Worth, TX, CCN 670103

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: carlotta.petersen@hca7.eclinicaldirectplus.com

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.

• Elite Orthopaedics of Irving PLLC

  • Orthopaedic Surgery Physician
  • Irving, TX
  • NPI 1982892105
  Medicare reassignment Care Compare group
• Surgery Associates of NTX, PLLC

  • Surgery Physician
  • Denton, TX
  • NPI 1134522691
  NPD (past)

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

• North Texas - Mca LLC

  dba Medical City Alliance

  • General Acute Care Hospital
  • Fort Worth, TX
  • NPI 1871911016
  Care Compare affiliation

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

{
    "created_epoch": "1264118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641427200000",
    "number": "1417288911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6750 N MACARTHUR BLVD STE 270",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750392469",
            "telephone_number": "877-314-8990",
            "fax_number": "844-364-3321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W MAIN ST STE 200",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "750573639",
            "telephone_number": "877-314-8990"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1050 E. Hwy. 114",
            "address_2": "Suite 100",
            "address_purpose": "LOCATION",
            "city": "Southlake",
            "state": "TX",
            "postal_code": "760925242",
            "country_code": "US",
            "telephone_number": "817-329-8364",
            "fax_number": "817-329-1285",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6750 N MacArthur Blvd Ste 270",
            "address_purpose": "LOCATION",
            "city": "Irving",
            "state": "TX",
            "postal_code": "750392469",
            "country_code": "US",
            "telephone_number": "877-314-8990",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "CARLOTTA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-01-22",
        "last_updated": "2022-01-06",
        "certification_date": "2021-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA00598",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA00598",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "CARLOTTA.PETERSEN@hca7.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "6750 N MacArthur Blvd Ste 270",
            "city": "Irving",
            "state": "TX",
            "country_code": "US",
            "postal_code": "750392469",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Physician Assistant in Lewisville, TX
• Providers in Lewisville, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2022; 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.