Active NPI
Ellen W Peterson, FAMILY NP
- Family Nurse Practitioner
- Worcester, MA
National Provider Identifier
1487833448
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 147918
- Practice address
- 170 Apricot St
Worcester, MA 01603-1225 - Phone
- (508) 799-3346
- Fax
- (508) 755-8054
- NPI assigned
- Oct 26, 2007
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 147918 | MA | Primary |
Addresses
Primary practice location
170 Apricot St
Worcester, MA 01603-1225
Mailing address
26 Queen St
Credentialing
Worcester, MA 01610-2473
Phone (508) 860-7962
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
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 147918 | MA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Heywood Medical Group Inc. | Family | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193356800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1452816000000",
"number": "1487833448",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26 QUEEN ST",
"address_2": "CREDENTIALING",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016102473",
"telephone_number": "508-860-7962",
"fax_number": "508-860-7929"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "170 APRICOT ST",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016031225",
"telephone_number": "508-799-3346",
"fax_number": "508-755-8054"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "ELLEN",
"middle_name": "W",
"credential": "FAMILY NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-10-26",
"last_updated": "2016-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MA",
"license": "147918",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Worcester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.