Active NPI
Daniel S Petersen, MD
- Sleep Medicine (Family Medicine) Physician
- Fitchburg, WI
National Provider Identifier
1578049763
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sleep Medicine (Family Medicine) Physician
- License
- 77190-20
- Practice address
- 2844 Index Rd
Fitchburg, WI 53713-3117 - Phone
- (608) 229-7979
- Fax
- (608) 229-8110
- NPI assigned
- Jul 11, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 125.073406 | IL | |
| Sleep Medicine (Family Medicine) Physician | 207QS1201X | 77190-20 | WI | Primary |
Addresses
Primary practice location
2844 Index Rd
Fitchburg, WI 53713-3117
Mailing address
2844 Index Rd
Fitchburg, WI 53713-3117
Phone (608) 229-7979
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578049763 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Sleep Medicine
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
2844 Index Rd
Fitchburg, WI 53713-3117
Phone (608) 229-7979
Hospital & facility affiliations
- SSM Health St Mary'S Hospital - Madison
- Upland Hills Health
- Stoughton Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125.073406 | IL | MD | Family Medicine Physician |
| 77190-20 | WI | MD | Sleep Medicine (Family Medicine) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dean Health Systems, Inc. | Current | Accepting new patients | |
| Dean Health Systems, Inc | Family Medicine | Current | Accepting new patients |
Locations
2844 Index Rd
Fitchburg, WI 53713
Phone (608) 229-7979
1808 W Beltline Hwy
Madison, WI 53713
Phone (608) 250-1497
515 22nd Ave
Monroe, WI 53566
Phone (608) 324-1000
Interoperability endpoints
- dpetersen431963@direct-ehr-ssmhc.com
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 and National Provider Directory roles.
-
- Durable Medical Equipment & Medical Supplies
- Portage, WI
- NPI 1427085679
Hospital & facility affiliations 10
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Madison, WI
- NPI 1184621211
-
- Critical Access Hospital
- Stoughton, WI
- NPI 1679558647
-
- Critical Access Hospital
- Dodgeville, WI
- NPI 1487745501
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1531267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1659484800000",
"number": "1578049763",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2844 INDEX RD",
"city": "FITCHBURG",
"state": "WI",
"postal_code": "537133117",
"telephone_number": "608-229-7979",
"fax_number": "608-229-8110"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2844 INDEX RD",
"city": "FITCHBURG",
"state": "WI",
"postal_code": "537133117",
"telephone_number": "608-229-7979",
"fax_number": "608-229-8110"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSEN",
"first_name": "DANIEL",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-07-11",
"last_updated": "2022-08-03",
"certification_date": "2022-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "125.073406",
"primary": false
},
{
"code": "207QS1201X",
"taxonomy_group": "",
"desc": "Family Medicine, Sleep Medicine",
"state": "WI",
"license": "77190-20",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1578049763",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fitchburg, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2022; 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.