Michael R Petersen, MD

Primary specialty

Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X

License

4301406847 Issued in MI

Practice address

2000 N Huron River Dr Ste 100
Ypsilanti, MI 48197

Phone

(734) 572-1200

Fax

(734) 572-9760

NPI assigned

Jun 28, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 5

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

93.01 of 100Reported as apm

Quality

86.02

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• Direct secure messaging: mpetersen@arcmi.intellechartdirect.net
• Direct secure messaging: michael.petersen.p1@direct.cei.nextgenshare.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.

• Cei Physicians PSC LLC

  • Ophthalmology Physician
  • Cincinnati, OH
  • NPI 1942296298
  Medicare reassignment
• Alliance Physicians Inc

  • Family Medicine Physician
  • Kettering, OH
  • NPI 1437125572
  NPD (past)
• Diabetes Reimbursement Specialists

  • Ophthalmology Physician
  • Atlanta, GA
  • NPI 1538453402
  NPD (past)

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596499200000",
    "number": "1629005160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39650 ORCHARD HILL PL STE 200",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483755391",
            "telephone_number": "248-319-0161",
            "fax_number": "248-319-0170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 N HURON RIVER DR STE 100",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "48197",
            "telephone_number": "734-572-1200",
            "fax_number": "734-572-9760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "MICHAEL",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-28",
        "last_updated": "2020-08-04",
        "certification_date": "2020-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "OH",
            "license": "35-06-3107",
            "primary": false
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Retina Specialist",
            "state": "MI",
            "license": "4301406847",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "180026057",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100374400",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000000021228",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0886528",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64930167",
            "state": "KY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mpetersen@arcmi.intellechartdirect.net",
            "affiliation": "N",
            "address_1": "2000 N Huron River Dr Ste 100",
            "city": "Ypsilanti",
            "state": "MI",
            "country_code": "US",
            "postal_code": "48197",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Perspective Alliance
• Anushey Pervez, DDS
• Gulafshan Pervez, D.D.S.
• Rebecca Isabelle Peshkin
• Stevany L Peters, M.D.
• Adam Fine Petraglia
• Emma-Leigh Petrock
• Dmitriy Petrov, M.D.
• Stella Petrovici, PHARMD
• Hoang Tran Pham, MD

• Retina Specialist (Ophthalmology) Physician in Ypsilanti, MI
• Providers in Ypsilanti, MI by specialty
• Retina Specialist (Ophthalmology) Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2020; 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.