Peterson Healthcare LLC – Family Medicine Physician

Key facts

NPI: 1609414168
Entity type: Organization (NPI type 2)
Primary specialty: Family Medicine Physician 207Q00000X
Legal business name: PETERSON HEALTHCARE LLC
Practice address: 217 N Harrison Ave Ste 109
Blanchard, OK 73010-6217
Phone: (405) 888-8483
Fax: (918) 803-4861
NPI assigned: Dec 16, 2019
Organization subpart: No

Authorized official

Name: Braden Peterson, APRN-CNP
Title: Nurse Practitioner / Owner
Phone: (405) 677-3378

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Steven G Bander, DO Family Medicine Physician · Blanchard, OK · NPI 1578545026

Medicare reassignment Care Compare group NPD FAMILY MEDICINE · OK
Shannon Michael, DNP, APRN, FNP-C Family Nurse Practitioner · Oklahoma City, OK · NPI 1720979131

Medicare reassignment Care Compare group NPD OK
Braden Peterson, APRN-CNP Family Nurse Practitioner · Blanchard, OK · NPI 1245762020

Medicare reassignment Care Compare group NPD OK
Billie Scott, APRN Family Nurse Practitioner · Marlow, OK · NPI 1083174700

NPD (past)

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA number	Laboratory	Certificate	Expires
37D2179425	Peterson Healthcare, LLC 217 N Harrison Ave, Ste 109, Blanchard, OK 73010	Certificate of waiver	Feb 23, 2028

Medicare participation

Medicare fee-for-service enrollment: Enrolled in OK

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20200124001837	OK	Part B Supplier - Clinic/Group Practice	6103251988	Receives reassigned benefits from 3 practitioners Practice locations: Del City, OK; Blanchard, OK

National Provider Directory

Locations

217 N Harrison Ave
Blanchard, OK 73010
Phone (405) 888-8483

217 N Harrison Ave
Ste 109
Blanchard, OK 73010
Phone (405) 266-0761

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Family Medicine Physician Group: 193400000X SINGLE SPECIALTY GROUP	207Q00000X			Yes
Urgent Care Clinic/Center	261QU0200X

Addresses

Primary practice location

217 N Harrison Ave Ste 109
Blanchard, OK 73010-6217

Mailing address

217 N Harrison Ave Ste 109
Blanchard, OK 73010-6217
Phone (405) 888-8483

Other practice location 1

3916 S Sunnylane Rd
Del City, OK 73115-3656
Phone (405) 677-3378

Other identifiers

Identifier	Type	State	Issuer
200882870A	Medicaid	OK
200882870B	Medicaid	OK

Other names

Excel Family Medical & Urgent Care Doing business as

Other providers in Blanchard, OK

Candice Paige Noyce, RD/LD
Braden O'Connor
Orthopaedic and Sports Medicine Center-Norman, P.C.
Ashley Owens, M.S., CCC-SLP
Katie Rae Owings
Peterson Medical LLC
Braden Peterson, APRN-CNP
Pharm Blanchard Acquisition LLC
Ediejo Placencio
Maria L Plata, M.ED, LPC, NCC

All providers in Blanchard, OK · Family Medicine Physician in Oklahoma

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 6, 2026. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Medicare Care Compare provider data (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.