Scott W Peterson, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

246 Issued in AK

Practice address

950 Bogard Rd
Suite 233
Wasilla, AK 99654-7105

Phone

(907) 352-2880

Fax

(907) 352-2885

NPI assigned

Mar 23, 2007

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 AK

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Medical Network of Alaska, LLC

  • Urgent Care Clinic/Center
  • Wasilla, AK
  • NPI 1538414834
  Medicare reassignment
• Medical Network of Alaska, LLC

  • Dermatology Physician
  • Wasilla, AK
  • NPI 1033883285
  NPD
• Medical Network of Alaska, LLC

  • Clinical Medical Laboratory
  • Wasilla, AK
  • NPI 1467167585
  NPD
• Medical Network of Alaska, LLC

  • Otolaryngology Physician
  • Anchorage, AK
  • NPI 1922862986
  NPD
• Mat Su Valley Medical Center LLC

  • Medicare Defined Swing Bed Hospital Unit
  • Palmer, AK
  • NPI 1003838384
  NPD (past)

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1720105901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 BOGARD RD",
            "address_2": "SUITE 233",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547105",
            "telephone_number": "907-352-2880",
            "fax_number": "907-352-2885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 BOGARD RD",
            "address_2": "SUITE 233",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547105",
            "telephone_number": "907-352-2880",
            "fax_number": "907-352-2885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "SCOTT",
        "middle_name": "W",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-23",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AK",
            "license": "246",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Darron Peterson, MPT, MED
• Emily Peterson, MD
• Laura Jean Peterson, M.D.
• Rebecca Lee Peterson
• Sarah Michelle Peterson
• Kirsten Marie Petron, LCSW, CDC II
• Christopher Orion Petruska
• John Jules Petty
• William C Petty
• Pharmacy Partners, LLC

• Physician Assistant in Wasilla, AK
• Providers in Wasilla, AK by specialty
• Physician Assistant in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.