Kevin W. Peterson, D.O.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

4172 Issued in IA

Practice address

307 E Scenic Valley Ave
Indianola, IA 50125-4865

Phone

(515) 961-8448

Fax

(515) 643-9100

NPI assigned

Jun 24, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kpeterson3954594@direct.trinity-health.org

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.

• Mercy Clinics, Inc.

  • Primary Care Clinic/Center
  • Clive, IA
  • NPI 1487670923
  Medicare reassignment NPD
• Mercy Clinics, Inc

  • Family Medicine Physician
  • Carlisle, IA
  • NPI 1295070118
  NPD
• Mercy Clinics, Inc.

  • Obstetrics & Gynecology Physician
  • Des Moines, IA
  • NPI 1508741505
  NPD
• Boone County Hospital

  • Critical Access Hospital
  • Boone, IA
  • NPI 1467434225
  NPD (past)

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

{
    "created_epoch": "1214265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572307200000",
    "number": "1669633343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1475",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503051475",
            "telephone_number": "515-961-8448",
            "fax_number": "515-643-9100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 E SCENIC VALLEY AVE",
            "city": "INDIANOLA",
            "state": "IA",
            "postal_code": "501254865",
            "telephone_number": "515-961-8448",
            "fax_number": "515-643-9100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "KEVIN",
        "middle_name": "W.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-24",
        "last_updated": "2019-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IA",
            "license": "DO-04172",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IA",
            "license": "4172",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julie Katherine Pasutti, RPH
• Kacy Paulsen, PHARM.D.
• Peace of Mind Counseling Services, LLC
• Andra Lee Peeler, MT-BC
• Heidi J Pendleton, MSW LCSW LISW
• Shelley Jolene Peterson, O.D.
• Sue Marie Peterson, MA LAT
• Warren Howard Peterson, O.D.
• Holly Pfeifer, DR
• Abigail Pilkington

• Pediatrics Physician in Indianola, IA
• Providers in Indianola, IA by specialty
• Pediatrics Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.