Amy K. Petersen, D.O.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

3913 Issued in IA

Practice address

6800 Lake Dr Ste 260
West Des Moines, IA 50266-2504

Phone

(515) 630-5022

Fax

(515) 630-5026

NPI assigned

Oct 4, 2006

Sex

Female

Sole proprietor

Yes

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 IA

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 Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: amy.petersen@148617396355076.direct.elationemr.com
• Direct secure messaging: apetersen12783@direct.unitypoint.org

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.

• Cornerstone Pediatrics and Family Allergy, PLC

  • Allergy Physician
  • West Des Monies, IA
  • NPI 1598325151

  Pediatrics

  Medicare reassignment NPD
• St Luke'S Methodist Hospital

  • General Acute Care Hospital
  • Cedar Rapids, IA
  • NPI 1083708226
  NPD
• Boone County Hospital

  • Critical Access Hospital
  • Boone, IA
  • NPI 1467434225
  NPD (past)

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596067200000",
    "number": "1730274523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6800 LAKE DR STE 260",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "502662504",
            "telephone_number": "515-630-5022",
            "fax_number": "515-630-5026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6800 LAKE DR STE 260",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "502662504",
            "telephone_number": "515-630-5022",
            "fax_number": "515-630-5026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "AMY",
        "middle_name": "K.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2020-07-30",
        "certification_date": "2020-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IA",
            "license": "3913",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Personalized Therapy, Inc
• Chanda Elizabeth Petermann, LMHC
• Dylan Peters, DPT
• Stephen Nicholas Peters, CADC
• Barbara Petersen-Fox, LISW
• Baylee Petersen
• Danielle Elaine Petersen
• Theresa Diane Petersen, RPH
• Ashley Wilke Peterson, APRN
• Brandon Keith Peterson, DDS

• Pediatrics Physician in West Des Moines, IA
• Providers in West Des Moines, IA by specialty
• Pediatrics Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2020; 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.