NPIMap

Individual provider Active NPI

Justine Peterson, PA-C

  • Physician Assistant
  • Sioux Falls, SD
National Provider Identifier
1669896676
Registry record updated Apr 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0914 Issued in SD
Practice address
1200 S 7TH Ave
Sioux Falls, SD 57105-0900
Phone
(605) 336-2140
Fax
(605) 336-1986
NPI assigned
Feb 11, 2014
Last updated
Apr 19, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0914 SD Primary

Addresses

Primary practice location

1200 S 7TH Ave
Sioux Falls, SD 57105-0900

Mailing address

1200 S 7TH Ave
Sioux Falls, SD 57105-0900
Phone (605) 504-5400

Other practice location 1

2501 W 22nd St
Sioux Falls, SD 57117
Phone (605) 336-3230 ext. 7628

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140519000463 SD Practitioner - Physician Assistant 2466675574 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Avera McKennanGroup PAC ID 0345157103, 957 clinicians

Practice addresses (Care Compare)

1200 S 7TH Ave
Sioux Falls, SD 57105-0900
Phone (605) 336-2140

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0914SDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Avera McKennan CurrentSince Feb 19, 2018 Accepting new patients
Avera McKennan Physician Assistant CurrentSince Feb 19, 2018 Accepting new patients
Avera McKennan Past Accepting new patients

Locations

1200 S 7th Ave
Sioux Falls, SD 57105
Phone (605) 336-2140

2501 W 22nd St
Sioux Falls, SD 57105

Interoperability endpoints

  • Direct secure messaging: justine.peterson@avera.sdhealthlink.net

Organizations & group practices 4

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.

  • Avera McKennan

    dba Avera McKennan Behavioral Health Clinic

    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • Sioux Falls, SD
    • NPI 1699009944
    Medicare reassignment Care Compare group
  • Avera McKennan

    dba Avera Interventional Radiology

    • Diagnostic Radiology Physician
    • Sioux Falls, SD
    • NPI 1053680678
    NPD
  • Avera McKennan

    dba Avera Medical Group

    • Family Medicine Physician
    • Sioux Falls, SD
    • NPI 1376575514

    Physician Assistant

    NPD
  • Avera McKennan

    dba Avera Medical Group 69th and Cliff

    • Family Medicine Physician
    • Sioux Falls, SD
    • NPI 1144635863
    NPD (past)

Hospital & facility affiliations 24

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1392076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650326400000",
    "number": "1669896676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 S 7TH AVE",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571050900",
            "telephone_number": "605-504-5400",
            "fax_number": "605-504-5150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 S 7TH AVE",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571050900",
            "telephone_number": "605-336-2140",
            "fax_number": "605-336-1986"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2501 W 22nd St",
            "address_purpose": "LOCATION",
            "city": "Sioux Falls",
            "state": "SD",
            "postal_code": "57117",
            "country_code": "US",
            "telephone_number": "605-336-3230 x7628",
            "fax_number": "605-373-4010",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JUSTINE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-02-11",
        "last_updated": "2022-04-19",
        "certification_date": "2022-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SD",
            "license": "0914",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux Falls, SD

Sources for this page

Verify at the official NPI Registry.