Bradley A Peterson, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

036109503 Issued in IL

Practice address

611 W. Park Street
Emergency Medicine
Urbana, IL 61801

Phone

(217) 383-3313

Fax

(217) 383-4014

NPI assigned

Apr 24, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

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 Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bpetersonmd24175@carlehiedirect.net

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.

• Carle Health Care Incorporated

  • Internal Medicine Physician
  • Urbana, IL
  • NPI 1154653947

  Emergency Medicine

  Medicare reassignment NPD
• Kirby Medical Center

  • Family Medicine Physician
  • Monticello, IL
  • NPI 1386635373
  Medicare reassignment NPD
• Kirby Medical Center

  • Critical Access Hospital
  • Monticello, IL
  • NPI 1730179847
  Medicare reassignment
• Kirby Medical Center

  • Community/Retail Pharmacy
  • Monticello, IL
  • NPI 1568074714
  NPD
• Gibson Community Hospital Association

  • Critical Access Hospital
  • Gibson City, IL
  • NPI 1114935681
  NPD (past)
• Hoopeston Emergency Medicine Specialists, LTD.

  • Emergency Medicine Physician
  • Hoopeston, IL
  • NPI 1316965197
  NPD (past)
• Illiana Emergency Physicians LLP

  • Emergency Medicine Physician
  • Greenville, IL
  • NPI 1730426941
  NPD (past)
• West Penn Allegheny Health System, Inc.

  • Cardiovascular Disease Physician
  • Pittsburgh, PA
  • NPI 1467466789
  NPD (past)

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

{
    "created_epoch": "1145836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1399507200000",
    "number": "1730145269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W PARK ST",
            "address_2": "BWPC",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618012529",
            "telephone_number": "217-383-6792",
            "fax_number": "217-383-4752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 W. PARK STREET",
            "address_2": "EMERGENCY MEDICINE",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "61801",
            "telephone_number": "217-383-3313",
            "fax_number": "217-383-4014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "BRADLEY",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-24",
        "last_updated": "2014-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036109503",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036-109503",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lisa Perry, MSQMHP
• Personal Performance Training & Rehabiliation, Inc.
• Persons Assuming Control of Their Environment
• Joyce Ojella Peter, MD
• Suma P Peter, MD
• Elizabeth Anne Peterson, MS
• Nicole M Peterson, PA
• Anthony Vinh Phan, DO
• James S Phares, PA
• Shara A. Phifer-Anderson, CRNA

• Emergency Medicine Physician in Urbana, IL
• Providers in Urbana, IL by specialty
• Emergency Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2014; 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.