James Lee Petersen, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1491 Issued in CO

Practice address

1025 Pennock PL Ste 1421
Fort Collins, CO 80524

Phone

(970) 495-8800

Fax

(970) 495-8820

NPI assigned

Apr 27, 2007

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CO, WY2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Banner Urgent Care ColoradoGroup PAC ID 7214295989, 23 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Banner Urgent Care Colorado

  • Urgent Care Clinic/Center
  • Loveland, CO
  • NPI 1902316995
  Medicare reassignment Care Compare group NPD
• Urgent Care Northern Colorado

  • Urgent Care Clinic/Center
  • Fort Collins, CO
  • NPI 1154025104
  Medicare reassignment
• Care United Medical Center of Laramie, LLC

  • Multi-Specialty Clinic/Center
  • Laramie, WY
  • NPI 1063720605

  CO

  Medicare reassignment
• Banner Urgent Care Colorado

  • Urgent Care Clinic/Center
  • Greeley, CO
  • NPI 1679055438
  NPD
• Poudre Valley Health Care, Inc

  • Medical Specialty Clinic/Center
  • Fort Collins, CO
  • NPI 1144535444
  NPD
• Pridemark Paramedic Services, LLC

  • Land Ambulance
  • Arvada, CO
  • NPI 1295761757
  NPD (past)

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

{
    "created_epoch": "1177632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574294400000",
    "number": "1467672774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 PENNOCK PL STE 1421",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805243257",
            "telephone_number": "970-495-8800",
            "fax_number": "970-495-8820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 PENNOCK PL STE 1421",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "80524",
            "telephone_number": "970-495-8800",
            "fax_number": "970-495-8820"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2127 E Harmony Rd",
            "address_2": "Suite 140",
            "address_purpose": "LOCATION",
            "city": "Fort Collins",
            "state": "CO",
            "postal_code": "805283405",
            "country_code": "US",
            "telephone_number": "970-297-6250",
            "fax_number": "970-297-6260",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2127 E Harmony Rd",
            "address_2": "Suite 140",
            "address_purpose": "LOCATION",
            "city": "Fort Collins",
            "state": "CO",
            "postal_code": "805283405",
            "country_code": "US",
            "telephone_number": "970-297-6250",
            "fax_number": "970-297-6260",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "JAMES",
        "middle_name": "LEE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-27",
        "last_updated": "2019-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "1491",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "75979837",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "126606300",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Glen Petcavage, D.C.
• Cassandra A Peter, RN
• Christy Peters
• Katherine Peters, LCSW
• Petersen Enterprises Inc
• Jennifer Petersen, M.A.
• Lyle Petersen, M.D.
• Tegan Cleo Petersen
• Aden Peterson, DDS
• Allie Peterson

• Physician Assistant in Fort Collins, CO
• Providers in Fort Collins, CO by specialty
• Physician Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2019; 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.