Todd J Petersen, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085-002723 Issued in IL

Practice address

6854 Parker Rd
Florissant, MO 63033-5313

Phone

(314) 286-6988

Fax

(314) 868-2561

NPI assigned

Oct 24, 2005

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 IL

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

State licenses

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

{
    "created_epoch": "1130112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713139200000",
    "number": "1740270537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6854 PARKER RD",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630335313",
            "telephone_number": "314-286-6988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6854 PARKER RD",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630335313",
            "telephone_number": "314-286-6988",
            "fax_number": "314-868-2561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "TODD",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-24",
        "last_updated": "2024-04-15",
        "certification_date": "2024-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-002723",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Personalized Home Health Care, LLC
• Personalized Homehealth Care Services
• Alberta Peters Herron, ARNP
• Golden Peters, PHARM.D
• Nicole Marie Petersen, PHARM.D.
• Allison Elizabeth Pettibone, MSW, LMSW
• Julie Pettit, PHARM D
• Kertonnia Petty-Miliken
• Lyra Rivera Phan, PT
• Phases of Care in-Home Services, LLC

• Physician Assistant in Florissant, MO
• Providers in Florissant, MO by specialty
• Physician Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2024; 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.