Deric Wymer Peterson, AU.D.

Primary specialty

AudiologistTaxonomy code 231H00000X

License

8599 Issued in MN

Practice address

1424 E College Dr Ste 200
Marshall, MN 56258-2087

Phone

(507) 532-2687

NPI assigned

Apr 26, 2010

Last updated

Dec 14, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Specialty

Qualified Audiologist

Education

University of Nebraska College of Medicine, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jka5 EnterprisesGroup PAC ID 3779800586, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Amdahl Hearing LLC

  • Audiologist-Hearing Aid Fitter
  • Saint Cloud, MN
  • NPI 1821168568
  NPD (past)
• Northland Hearing Centers, Inc.

  dba All American Hearing

  • Hearing and Speech Clinic/Center
  • Sparta, IL
  • NPI 1184677791
  NPD (past)

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

{
    "created_epoch": "1272240000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323820800000",
    "number": "1659698959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1424 E COLLEGE DR STE 200",
            "city": "MARSHALL",
            "state": "MN",
            "postal_code": "562582087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1424 E COLLEGE DR STE 200",
            "city": "MARSHALL",
            "state": "MN",
            "postal_code": "562582087",
            "telephone_number": "507-532-2687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "DERIC",
        "middle_name": "WYMER",
        "name_prefix": "Dr.",
        "credential": "AU.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-04-26",
        "last_updated": "2011-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "MN",
            "license": "8599",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nishant Parmar, M.D.
• Terence James Parr, M.D.
• Chorus Paw
• Conner Lee Paxton
• Adam Peters, OD
• Jessica Ann Peterson, DC
• Kevin Warren Peterson, CRNA
• Kimberly Peterson, DNP, CPNP-PC
• Daisy Pierson
• Derrik Scott Pinckney, D.C.

• Audiologist in Marshall, MN
• Providers in Marshall, MN by specialty
• Audiologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.