David Petersen, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

255 Issued in CO

Practice address

6200 S Syracuse Way Ste 260
Greenwood Village, CO 80111-4739

Phone

(719) 332-6767

NPI assigned

Oct 15, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CO, TX2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Clinical Social Worker

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sondermind Provider Network LLCGroup PAC ID 9537572490, 1,295 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Sondermind Provider Network LLC

  • Clinical Social Worker
  • Denver, CO
  • NPI 1760854442

  TX

  Medicare reassignment Care Compare group NPD
• Franciscan Community Counseling, Inc.

  • Clinical Social Worker
  • Colorado Springs, CO
  • NPI 1134711641
  NPD

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

{
    "created_epoch": "1160870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674691200000",
    "number": "1497845788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 N TEJON ST",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809031101",
            "telephone_number": "719-332-6767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6200 S SYRACUSE WAY STE 260",
            "city": "GREENWOOD VILLAGE",
            "state": "CO",
            "postal_code": "801114739",
            "telephone_number": "719-332-6767"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "415 N Tejon St",
            "address_purpose": "LOCATION",
            "city": "Colorado Springs",
            "state": "CO",
            "postal_code": "809031101",
            "country_code": "US",
            "telephone_number": "719-440-0025",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "DAVID",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-15",
        "last_updated": "2023-01-26",
        "certification_date": "2023-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CO",
            "license": "81",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "255",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "099366",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Performance Sports Medical Center LLC
• Monica Alexis Perlman
• Kendal Perry, BCBA
• Meagan Perry
• Genesis Perrymond, CAA
• Peterson Foot Care, Inc.
• Ashleigh Peterson
• Carissa Peterson, RN
• Christine Jane Peterson, NURSE PRACTITIONER
• Elizabeth Anne Peterson, O.D.

• Clinical Social Worker in Greenwood Village, CO
• Providers in Greenwood Village, CO by specialty
• Clinical Social Worker in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2023; 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.