NPIMap

Individual provider Active NPI

Tonja S Petersen - Anderson, ARNP

  • Nurse Practitioner
  • Lake City, IA
National Provider Identifier
1487626719
Registry record updated Sep 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
A097418 Issued in IA
Practice address
1351 W Main St
Lake City, IA 51449-1585
Phone
(712) 464-7907
Fax
(712) 464-7412
NPI assigned
Feb 2, 2006
Last updated
Sep 10, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X A097418 IA Primary

Addresses

Primary practice location

1351 W Main St
Lake City, IA 51449-1585

Mailing address

1351 W Main St
PO Box 114
Lake City, IA 51449-1585
Phone (712) 464-7907

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051109000683 IA Practitioner - Nurse Practitioner 8123046026 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1301 W Main St
Lake City, IA 51449-1585
Phone (712) 464-3171

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.59 of 100Reported as group
Quality
90
Promoting interoperability
84
Improvement activities
40
Cost
71.97

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
A097418IAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Stewart Memorial Community Hospital Nurse Practitioner CurrentSince Mar 2, 2015 Accepting new patients
St Luke's Methodist Hospital Current Accepting new patients
Stewart Memorial Community Hospital Nurse Practitioner Current Accepting new patients
Stewart Memorial Community Hospital CurrentSince Mar 2, 2015 Accepting new patients
Stewart Memorial Community Hospital Nurse Practitioner Past Accepting new patients

Locations

1800 Main St
Gowrie, IA 50543
Phone (515) 352-3876

1301 W Main St
Lake City, IA 51449
Phone (712) 464-3171

1351 W Main St
Lake City, IA 51449
Phone (712) 464-7907

505 E Lake St
Rockwell City, IA 50579
Phone (712) 297-8989

Interoperability endpoints

  • Direct secure messaging: tpetersenanderson4513@direct.unitypoint.org

Organizations & group practices 5

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.

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1138838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441843200000",
    "number": "1487626719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1351 W MAIN ST",
            "address_2": "PO BOX 114",
            "city": "LAKE CITY",
            "state": "IA",
            "postal_code": "514491585",
            "telephone_number": "712-464-7907",
            "fax_number": "712-464-7412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1351 W MAIN ST",
            "city": "LAKE CITY",
            "state": "IA",
            "postal_code": "514491585",
            "telephone_number": "712-464-7907",
            "fax_number": "712-464-7412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN - ANDERSON",
        "first_name": "TONJA",
        "middle_name": "S",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-02",
        "last_updated": "2015-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IA",
            "license": "A097418",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake City, IA

Sources for this page

Verify at the official NPI Registry.