Madison Nicole Petersen, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

737 N Michigan Ave Ste 720
Chicago, IL 60611-6661

Phone

(312) 319-1978

Fax

(312) 262-7791

NPI assigned

Sep 11, 2024

Sex

Female

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 IL

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, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jordan C Carqueville MD LLCGroup PAC ID 6709116361, 10 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Jordan C. Carqueville, MD LLC

  • Dermatology Physician
  • Chicago, IL
  • NPI 1710531330
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1726012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736553600000",
    "number": "1467288043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 N YORK RD STE 100",
            "city": "HINSDALE",
            "state": "IL",
            "postal_code": "605213515",
            "telephone_number": "312-319-1978",
            "fax_number": "312-262-7791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "737 N MICHIGAN AVE STE 720",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606116661",
            "telephone_number": "312-319-1978",
            "fax_number": "312-262-7791"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "920 N York Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Hinsdale",
            "state": "IL",
            "postal_code": "605213515",
            "country_code": "US",
            "telephone_number": "312-319-1978",
            "fax_number": "312-262-7791",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1945 W Wilson Ave Ste 6119",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606405259",
            "country_code": "US",
            "telephone_number": "312-319-1978",
            "fax_number": "312-262-7791",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "MADISON",
        "middle_name": "NICOLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-11",
        "last_updated": "2025-01-11",
        "certification_date": "2025-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anna Petersen, MD
• Brooke Noel Petersen, LPC
• Elizabeth Petersen
• Erin Kathleen Petersen, MD
• Katherine Petersen, PA
• Robyn Petersen
• Sierra Petersen, LCSW
• Valerie L Petersen, WHNP-BC
• Lauren Petersil
• Peterson Chiropractic Clinic SC

• Physician Assistant in Chicago, IL
• Providers in Chicago, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 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.
• 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.