Ellen Davis Peterson, CNS

Primary specialty

Clinical Nurse SpecialistTaxonomy code 364S00000X

License

2007004651 Issued in TX

Practice address

6500 North Mopac Expressway
Building 3, Suite 200
Austin, TX 78731

Phone

(512) 458-8400

Fax

(512) 458-8593

NPI assigned

Oct 5, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Ellen C. Walter Former name

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Certified Clinical Nurse Specialist (CNS)

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St Davids Heart and Vascular PLLCGroup PAC ID 7012821879, 197 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Specialist, Master of Science

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 and National Provider Directory roles.

• St Davids Heart & Vascular, PLLC

  • Cardiovascular Disease Physician
  • Austin, TX
  • NPI 1700887700
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1191542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447027200000",
    "number": "1649468406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6500 NORTH MOPAC EXPRESSWAY",
            "address_2": "BUILDING 3, SUITE 200",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "78731",
            "telephone_number": "512-458-8400",
            "fax_number": "512-458-8593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6500 NORTH MOPAC EXPRESSWAY",
            "address_2": "BUILDING 3, SUITE 200",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "78731",
            "telephone_number": "512-458-8400",
            "fax_number": "512-458-8593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "ELLEN",
        "middle_name": "DAVIS",
        "credential": "CNS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-05",
        "last_updated": "2015-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364S00000X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist",
            "state": "TX",
            "license": "2007004651",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELLEN",
            "last_name": "WALTER",
            "middle_name": "C.",
            "credential": "CNS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Cory Peterson, P.T., D.P.T.
• Craig Jon Peterson, M.D.
• Daniel Peterson
• Daniel L Peterson, M.D.
• David Matthew Peterson, PT
• Genevieve Peterson
• Hahja Lynne Peterson, DC
• Jasmine Peterson, PHARMD
• Jessica Nicole Peterson, OTD, OTR, IBCLC
• Kari Ann Peterson

• Clinical Nurse Specialist in Austin, TX
• Providers in Austin, TX by specialty
• Clinical Nurse Specialist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2015; 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.