Marc Zephire Peterson, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

CRNA1248 Issued in AZ

Practice address

101 Civic Center Lane
Havasu Regional Medical Center
Lake Havasu, AZ 86403

Phone

(928) 505-5760

NPI assigned

Sep 1, 2016

Last updated

Nov 8, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cedar Anesthesia Group LLPGroup PAC ID 0345240966, 11 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Intermountain Health Cedar City Hospital Hospital, Cedar City, UT, CCN 460007

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Cedar Anesthesia Group LLP

  • Certified Registered Nurse Anesthetist
  • Cedar City, UT
  • NPI 1821176132

  Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• Amsurg St George Anesthesia, LLC

  • Anesthesiology Physician
  • St George, UT
  • NPI 1730452814
  Medicare reassignment NPD
• St George Endoscopy Center LLC

  dba St. George Endoscopy Center

  • Ambulatory Surgical Clinic/Center
  • St George, UT
  • NPI 1457325573
  NPD (past)

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

• Ihc Health Services, Inc.

  dba Intermountain Health Cedar City Hospital

  • General Acute Care Hospital
  • Cedar City, UT
  • NPI 1538178801
  Care Compare affiliation

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

{
    "created_epoch": "1472688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478563200000",
    "number": "1609323260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2770 SQUALL KING DR",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864043304",
            "telephone_number": "801-870-3968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 CIVIC CENTER LANE",
            "address_2": "HAVASU REGIONAL MEDICAL CENTER",
            "city": "LAKE HAVASU",
            "state": "AZ",
            "postal_code": "86403",
            "telephone_number": "928-505-5760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "MARC",
        "middle_name": "ZEPHIRE",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-09-01",
        "last_updated": "2016-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AZ",
            "license": "CRNA1248",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "KS",
            "license": "14-126823-061",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "UT",
            "license": "5909731-3102",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AZ",
            "license": "RN202234",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Arizona Havasu BDM Pak LLC (Bridge Lake Dental)
• Assisted Living Concepts Inc (Jasmine House)
• First Care Medical Supply Inc
• Charles Reese Mead, D.D.S.
• Allen Dene Smith, DDS
• Usv Optical Inc

• Certified Registered Nurse Anesthetist in Lake Havasu, AZ
• Providers in Lake Havasu, AZ by specialty
• Certified Registered Nurse Anesthetist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.