Pam Petersen Hearing Services LLC

Primary specialty

AudiologistTaxonomy code 231H00000X

License

29 Issued in CO

Legal business name

PAM PETERSEN HEARING SERVICES LLC

Practice address

11931 4050 Rd
Paonia, CO 81428-6418

Phone

(970) 527-6290

Fax

(970) 527-3354

NPI assigned

Feb 9, 2008

Organization subpart

No

Name

Ms. Pamela R. Petersen, MS, CCC-ANPI 1932267523

Title

Owner/Audiologist

Phone

(970) 527-6290

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Pamela R Petersen, AUD

  • Specialist
  • Paonia, CO
  • NPI 1932267523

  CO

  Medicare reassignment NPD Authorized official

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 11, 2008.

{
    "created_epoch": "1202515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202688000000",
    "number": "1497933675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11931 4050 RD",
            "city": "PAONIA",
            "state": "CO",
            "postal_code": "814286418",
            "telephone_number": "970-527-6290",
            "fax_number": "970-527-3354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11931 4050 RD",
            "city": "PAONIA",
            "state": "CO",
            "postal_code": "814286418",
            "telephone_number": "970-527-6290",
            "fax_number": "970-527-3354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAM PETERSEN HEARING SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-09",
        "last_updated": "2008-02-11",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "OWNER/AUDIOLOGIST",
        "authorized_official_telephone_number": "970-527-6290",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MS, CCC-A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Audiologist",
            "state": "CO",
            "license": "29",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07114556",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Paonia, CO
• Audiologist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.