NPIMap

Individual provider Active NPI

Eric Scott Petersen, D.O.

  • Family Medicine Physician
  • Maquoketa, IA
National Provider Identifier
1538149042
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
03059 Issued in IA
Practice address
918 W Platt St # 1
Maquoketa, IA 52060-2038
Phone
(563) 652-5145
Fax
(563) 652-3674
NPI assigned
Jan 19, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 03059 IA Primary

Addresses

Primary practice location

918 W Platt St # 1
Maquoketa, IA 52060-2038

Mailing address

918 W Platt St # 1
Maquoketa, IA 52060-2038
Phone (563) 652-5145

Other identifiers 6

IdentifierTypeStateIssuer
4210571962002OtherIAJOHN DEERE HEALTHCARE
03059OtherIAIOWA LICENSE
080120570OtherIARAILROAD MEDICARE
2147512MedicaidIA
1147512MedicaidIA
44479OtherIAWELLMARK BLUE CROSS

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address eric.petersen@mamaq.directbygreenway.com Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091203000661 IA Practitioner - Family Practice 9234142258 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

307 E Wester PO Box
Suite 58
Wyoming, IA 52362
Phone (563) 488-2297

411 W White St
Preston, IA 52069-9570
Phone (563) 689-3201

918 W Platt St
Suite 1
Maquoketa, IA 52060-2038

918 W Platt St
Suite 1
Maquoketa, IA 52060-2063
Phone (563) 652-5145

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.44 of 100Reported as group
Quality
81.4
Improvement activities
40
Cost
79.6

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions52
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
03059IAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Associates of Maquoketa, P.C. Family Medicine Current Accepting new patients
Boone County Hospital Past Accepting new patients

Locations

918 W Platt St
Ste 1
Maquoketa, IA 52060
Phone (563) 652-5145

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1137628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1538149042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "918 W PLATT ST # 1",
            "city": "MAQUOKETA",
            "state": "IA",
            "postal_code": "520602038",
            "telephone_number": "563-652-5145",
            "fax_number": "563-652-3674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "918 W PLATT ST # 1",
            "city": "MAQUOKETA",
            "state": "IA",
            "postal_code": "520602038",
            "telephone_number": "563-652-5145",
            "fax_number": "563-652-3674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "ERIC",
        "middle_name": "SCOTT",
        "name_prefix": "Mr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-19",
        "last_updated": "2023-03-07",
        "certification_date": "2021-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "03059",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE HEALTHCARE",
            "identifier": "4210571962002",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IOWA LICENSE",
            "identifier": "03059",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080120570",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2147512",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1147512",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BLUE CROSS",
            "identifier": "44479",
            "state": "IA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "eric.petersen@mamaq.directbygreenway.com",
            "affiliation": "N",
            "endpointDescription": "secure email address",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "medical information",
            "address_1": "918 W Platt St # 1",
            "city": "Maquoketa",
            "state": "IA",
            "country_code": "US",
            "postal_code": "520602038",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Maquoketa, IA

Sources for this page

Verify at the official NPI Registry.