Elisabeth M Peterson, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D12105 Issued in MN

Practice address

2500 Como Avenue
St. Paul, MN 55108-1460

Phone

(651) 999-4600

Fax

(651) 632-8984

NPI assigned

Jul 1, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Group Health, Inc.

  • Multi-Specialty Clinic/Center
  • Minneapolis, MN
  • NPI 1710924683
  Medicare reassignment NPD
• Group Health, Inc.

  • General Practice Dentistry
  • Bloomington, MN
  • NPI 1922153881
  NPD
• Group Health, Inc.

  • General Practice Dentistry
  • Saint Paul, MN
  • NPI 1952042053

  Oral and Maxillofacial Surgery

  NPD

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

{
    "created_epoch": "1246406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1333065600000",
    "number": "1508094244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 COMO AVENUE",
            "city": "ST. PAUL",
            "state": "MN",
            "postal_code": "551081460",
            "telephone_number": "651-999-4600",
            "fax_number": "651-632-8984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 COMO AVENUE",
            "city": "ST. PAUL",
            "state": "MN",
            "postal_code": "551081460",
            "telephone_number": "651-999-4600",
            "fax_number": "651-632-8984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "ELISABETH",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-01",
        "last_updated": "2012-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MN",
            "license": "D12105",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Barbara Lynn Peterson, PA
• Bjorn Karl Peterson, M.D.
• Daniel S Peterson, D.C.
• David Donald Peterson, D.C.
• Deborah Anne Peterson
• Emily Jean Peterson, DC
• Eric Bradley Peterson
• Erin Peterson
• Hunter David Peterson, DO
• Jeffrey J Peterson, MD

• Oral and Maxillofacial Surgery (Dentist) in St. Paul, MN
• Providers in St. Paul, MN by specialty
• Oral and Maxillofacial Surgery (Dentist) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2012; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.