Courtney Slocum Petersen, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2624 Issued in MA

Practice address

750 Washington St # 178
Tufts Medical Center
Boston, MA 02111-1526

Phone

(617) 636-8200

Fax

(617) 636-7587

NPI assigned

Jun 20, 2005

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Atlanta Brain and Spine Care, P.C.

  • Neurological Surgery Physician
  • Atlanta, GA
  • NPI 1659376275
  NPD (past)
• Piedmont Providers LLC

  • Internal Medicine Physician
  • Jasper, GA
  • NPI 1548273592
  NPD (past)

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

{
    "created_epoch": "1119225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452729600000",
    "number": "1730184375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "57 E CONCORD ST",
            "address_2": "APT 3",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021181996",
            "telephone_number": "770-519-8108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 WASHINGTON ST # 178",
            "address_2": "TUFTS MEDICAL CENTER",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021111526",
            "telephone_number": "617-636-8200",
            "fax_number": "617-636-7587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "COURTNEY",
        "middle_name": "SLOCUM",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-06-20",
        "last_updated": "2016-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "004199",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "2624",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "000867701",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah Wilson Peters, MD
• Shannon McKenzie Peters, PHD
• Whitney Elise Peters, M.D.
• Samantha Petersen-Cash, LCSW
• Carla Petersen, AU.D., CCC-A
• Elizabeth Mae Petersen, M.D.
• Kay M Petersen, M.D.
• Maria Elizabeth Petersen, MSPT
• Robert Allen Petersen, MD
• Timothy J Petersen, PHD

• Physician Assistant in Boston, MA
• Providers in Boston, MA by specialty
• Physician Assistant in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.