Active NPI
John L Petersen, MD
- Interventional Cardiology Physician
- Roxboro, NC
National Provider Identifier
1629026893
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Interventional Cardiology Physician
- License
- 9800115
- Practice address
- 615 Ridge Rd
Roxboro, NC 27573-4629 - Phone
- (336) 599-2121
- NPI assigned
- May 4, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Interventional Cardiology Physician | 207RI0011X | 9800115 | NC | Primary |
Addresses
Primary practice location
615 Ridge Rd
Roxboro, NC 27573-4629
Mailing address
615 Ridge Rd
Roxboro, NC 27573-4629
Phone (336) 599-2121
Other practice location 1
550 17th Ave Ste 680
Seattle, WA 98122-5795
Phone (206) 215-4545
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jpetersen1042929@wm.providencedirect.org | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090225000698 | WA | Practitioner - Interventional Cardiology | 5193716579 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Interventional Cardiology
- Education
- University of Washington School of Medicine, 1995
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Swedish Health Services
Practice addresses (Care Compare)
550 17TH Ave
FL 6
Seattle, WA 98122-5788
Phone (206) 861-8550
Hospital & facility affiliations
- Swedish Medical Center / Cherry Hill
- Swedish Medical Center
- Swedish Issaquah
- Swedish Edmonds Hospital
- Olympic Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 87.46 of 100
- Quality
- 80.66
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 77.55
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Coronary angioplasty and stenting | 20 |
| Pacemaker insertion or repair | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9800115 | NC | MD | Interventional Cardiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Swedish Health Services | Current | Accepting new patients | |
| Swedish Health Services | Current | Accepting new patients | |
| Swedish Health Services | Past | Accepting new patients |
Locations
12917 SE 38th St
Ste 100
Bellevue, WA 98006
Phone (206) 292-7990
7320 216th St SW
Ste 210
Edmonds, WA 98026
Phone (206) 292-7990
22707 SE 29th St
Sammamish, WA 98075
Phone (425) 455-2845
550 17th Ave
Ste 680
Seattle, WA 98122
Phone (206) 320-5392
800 5th Ave
Ste 600
Seattle, WA 98104
550 17th Ave
Fl 6
Seattle, WA 98122
Organizations & group practices 3
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.
-
- Cardiovascular Disease Physician
- Edmonds, WA
- NPI 1659328177
-
- Surgery Physician
- Seattle, WA
- NPI 1053368571
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Port Angeles, WA
- NPI 1306845557
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602028800000",
"number": "1629026893",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "615 RIDGE RD",
"city": "ROXBORO",
"state": "NC",
"postal_code": "275734629",
"telephone_number": "336-599-2121"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "615 RIDGE RD",
"city": "ROXBORO",
"state": "NC",
"postal_code": "275734629",
"telephone_number": "336-599-2121"
}
],
"practiceLocations": [
{
"address_1": "550 17th Ave Ste 680",
"address_purpose": "LOCATION",
"city": "Seattle",
"state": "WA",
"postal_code": "981225795",
"country_code": "US",
"telephone_number": "206-215-4545",
"fax_number": "206-215-4550",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PETERSEN",
"first_name": "JOHN",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-04",
"last_updated": "2020-10-07",
"certification_date": "2020-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "207RI0011X",
"taxonomy_group": "",
"desc": "Internal Medicine, Interventional Cardiology",
"state": "NC",
"license": "9800115",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "jpetersen1042929@wm.providencedirect.org",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "550 17th Ave Ste 680",
"city": "Seattle",
"state": "WA",
"country_code": "US",
"postal_code": "981225795",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Roxboro, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 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.