Active NPI
Kathleen B Petersen, MD
- Obstetrics & Gynecology Physician
- Augusta, ME
National Provider Identifier
1487632675
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- 012473
- Practice address
- 5 Caldwell Rd
Augusta, ME 04330-5739 - Phone
- (207) 623-1322
- NPI assigned
- Jan 6, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 012473 | ME | Primary |
Addresses
Primary practice location
5 Caldwell Rd
Augusta, ME 04330-5739
Mailing address
5 Caldwell Rd
Augusta, ME 04330-5739
Phone (207) 623-1322
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 257240099 | Medicaid | ME | |
| 005243 | Other | ME | ANTHEM |
| 1041118 | Other | ME | AETNA |
| 6191075 | Other | ME | CIGNA |
| B86469 | Other | ME | HARVARD PILGRIM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 012473 | ME | MD | Obstetrics & Gynecology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136505600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1393286400000",
"number": "1487632675",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 CALDWELL RD",
"city": "AUGUSTA",
"state": "ME",
"postal_code": "043305739",
"telephone_number": "207-623-1322"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5 CALDWELL RD",
"city": "AUGUSTA",
"state": "ME",
"postal_code": "043305739",
"telephone_number": "207-623-1322"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSEN",
"first_name": "KATHLEEN",
"middle_name": "B",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-06",
"last_updated": "2014-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "ME",
"license": "012473",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "257240099",
"state": "ME"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "005243",
"state": "ME"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "1041118",
"state": "ME"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "6191075",
"state": "ME"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PILGRIM",
"identifier": "B86469",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Augusta, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.