Pamela Peterson

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

304004 Issued in MN

Practice address

332 W Superior St Ste 300
Duluth, MN 55802

Phone

(218) 722-4379

NPI assigned

Aug 9, 2016

Sex

Female

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 MN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Nystrom and Associates LTDGroup PAC ID 6406752492, 590 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Nystrom & Associates, LTD

  • Clinical Social Worker
  • New Brighton, MN
  • NPI 1396750188
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1470700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615766400000",
    "number": "1700330503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 SILVER LAKE ROAD NW",
            "address_2": "SUITE 110",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "55112",
            "telephone_number": "651-379-1718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "332 W SUPERIOR ST STE 300",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "55802",
            "telephone_number": "218-722-4379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "PAMELA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-09",
        "last_updated": "2021-03-15",
        "certification_date": "2021-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "26251",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "304004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joshua M Peterson, PA-C
• Katie Beth Peterson, PT
• Keith Hershel Peterson, MD
• Kraig Robert Peterson, LGSW
• Marin E Peterson, CNP
• Robert W Peterson, CRNA
• Ross Leksell Peterson, CRNA
• Travis Reino Peterson
• Petoskey, Inc.
• Michael Petry, M.D.

• Addiction (Substance Use Disorder) Counselor in Duluth, MN
• Providers in Duluth, MN by specialty
• Addiction (Substance Use Disorder) Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2021; 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.