Michelle A Petersen, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1204 Issued in NE

Practice address

4004 Pioneer Woods Dr
Lincoln, NE 68506-7548

Phone

(402) 484-4900

Fax

(402) 484-6456

NPI assigned

Feb 16, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Michelle A Buller Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Specialty

Physician Assistant

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

82.33 of 100Reported as subgroup

Quality

67.51

Promoting interoperability

96

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: michelle.petersen@neb.ikm.direct-ci.com

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.

• Alegent Creighton Clinic

  dba CHI Health Clinic

  • Family Medicine Physician
  • Omaha, NE
  • NPI 1548287907
  NPD (past)
• Alegent Creighton Clinic

  dba CHI Health Clinic

  • Family Medicine Physician
  • Council Bluffs, IA
  • NPI 1598811069

  Physician Assistant

  NPD (past)

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

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682899200000",
    "number": "1538203476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4004 PIONEER WOODS DR",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685067548",
            "telephone_number": "402-484-4900",
            "fax_number": "402-484-6456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4004 PIONEER WOODS DR",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685067548",
            "telephone_number": "402-484-4900",
            "fax_number": "402-484-6456"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4001 Pioneer Woods Dr",
            "address_purpose": "LOCATION",
            "city": "Lincoln",
            "state": "NE",
            "postal_code": "685067547",
            "country_code": "US",
            "telephone_number": "402-484-4900",
            "fax_number": "402-484-6456",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "MICHELLE",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-16",
        "last_updated": "2023-05-01",
        "certification_date": "2023-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "001911",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NE",
            "license": "1204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "michelle.petersen@neb.ikm.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "Nebraska Hematology-Oncology, PC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "4004 Pioneer Woods Dr",
            "city": "Lincoln",
            "state": "NE",
            "country_code": "US",
            "postal_code": "685067548",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "BULLER",
            "middle_name": "A",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jennifer Suzanne Petersen, RN, IBCLC
• Lindsey Petersen
• Malinda Lee Petersen
• Matthew L Petersen, DO
• Megan Petersen, PHARMD
• Michelle B Petersen, M.D.
• Paul F Petersen, MD
• Sharee Petersen
• Sydney Rae Petersen, PA
• Peterson Chiropractic Inc (SouthPointe Chiropractic)

• Physician Assistant in Lincoln, NE
• Providers in Lincoln, NE by specialty
• Physician Assistant in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 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.