Andrea Nicole Petersen, DNP, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

2020026948 Issued in MO

Practice address

2410 S Limit Ave
Sedalia, MO 65301-6910

Phone

(573) 814-1170

Fax

(573) 530-1037

NPI assigned

Aug 14, 2020

Last updated

Aug 6, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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 MO

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

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Big Tree Medical Group LLCGroup PAC ID 6507232543, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: andrea.petersen@115443077021700.direct.elationemr.com

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.

• Big Tree Medical Group LLC

  dba Big Tree Medical Home

  • Family Medicine Physician
  • Columbia, MO
  • NPI 1740858562
  Medicare reassignment Care Compare group NPD
• Little Tree Pediatric Urgent Care LLC

  • Urgent Care Clinic/Center
  • Columbia, MO
  • NPI 1992418461
  NPD (past)

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

{
    "created_epoch": "1597363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722902400000",
    "number": "1669083382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "807 LA GRAND DR",
            "city": "SEDALIA",
            "state": "MO",
            "postal_code": "653017965",
            "telephone_number": "660-596-1605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2410 S LIMIT AVE",
            "city": "SEDALIA",
            "state": "MO",
            "postal_code": "653016910",
            "telephone_number": "573-814-1170",
            "fax_number": "573-530-1037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "ANDREA",
        "middle_name": "NICOLE",
        "name_prefix": "Ms.",
        "credential": "DNP, FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-14",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2020026948",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pearle Vision Inc (Pearle Vision #C6210)
• Amy Perez
• Rodingson Ramos Perez, P.T.
• Perusich Chiropractic Associates, LLC (Backbone of Health)
• Michael R Perusich, DC
• Pettis County Ambulance District
• Pettis County Assisted Living, L.L.C.
• Pettis County Board of Services for the Developmentally Disabled
• Pettis County Health Center
• Pettis Emergency Group LLC

• Family Nurse Practitioner in Sedalia, MO
• Providers in Sedalia, MO by specialty
• Family Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2024; 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.