Petersen Neurospine, PLLC

Primary specialty

Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X

Legal business name

PETERSEN NEUROSPINE, PLLC

Practice address

6701 Airport Blvd
Building D Suite 100
Mobile, AL 36608-6765

Phone

(251) 607-6117

Fax

(251) 219-0746

NPI assigned

Sep 30, 2019

Organization subpart

No

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

Authorized official

Name

Bendt P Petersen III, MDNPI 1477510915

Title

Physician

Phone

(251) 607-6117

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

Locations

Practitioners 3

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

• Bendt P Petersen III, M.D.

  • Orthopaedic Surgery of the Spine Physician
  • Mobile, AL
  • NPI 1477510915
  Medicare reassignment Care Compare group NPD Authorized official
• Rebecca Ross Estes, CRNP

  • Family Nurse Practitioner
  • Mobile, AL
  • NPI 1710527098
  Medicare reassignment Care Compare group NPD
• Shireen S Knowles, CRNP

  • Family Nurse Practitioner
  • Mobile, AL
  • NPI 1336441500
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1569801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659571200000",
    "number": "1639710882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6701 AIRPORT BLVD",
            "address_2": "BUILDING D SUITE 100",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366086765",
            "telephone_number": "251-607-6117",
            "fax_number": "251-219-0746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6701 AIRPORT BLVD",
            "address_2": "BUILDING D SUITE 100",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366086765",
            "telephone_number": "251-607-6117",
            "fax_number": "251-219-0746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSEN NEUROSPINE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-30",
        "last_updated": "2022-08-04",
        "certification_date": "2022-08-04",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "BENDT",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "251-607-6117",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207XS0117X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "248545",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brandon Mark Peters, M.D
• Danielle Morris Peters, MSOTR/L
• Kelsey Nutt Peters, DDS
• Melissa Leigh Peters, MD
• Brandon M. Peters,
• Bendt P Petersen III, M.D.
• Madison Petersen, MD
• Dylan Peterson
• Erin Peterson
• Sarah Lisa Peterson, APRN, CNP

• Orthopaedic Surgery of the Spine Physician in Mobile, AL
• Providers in Mobile, AL by specialty
• Orthopaedic Surgery of the Spine Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.