Matthew D Peterson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

4071-23 Issued in WI

Practice address

10400 75TH St
Kenosha, WI 53142-7884

Phone

(262) 948-5600

NPI assigned

Jul 14, 2017

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

Electronic endpoints 6

Medicare fee-for-service enrollment

Enrolled in WI

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

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Aurora Medical Center Kenosha Hospital, Kenosha, WI, CCN 520189
• Aurora Memorial Hospital Burlington Hospital, Burlington, WI, CCN 520059

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mpeterson176231@direct.myadvocateaurora.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.

• Aurora Medical Group, Inc.

  • Certified Registered Nurse Anesthetist
  • Milwaukee, WI
  • NPI 1427271378
  Medicare reassignment Care Compare group
• Aurora Medical Group, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Oshkosh, WI
  • NPI 1326858044
  NPD
• Aurora Medical Group, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Milwaukee, WI
  • NPI 1659599157
  NPD
• Aurora Medical Group, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Manitowoc, WI
  • NPI 1801941075
  NPD (past)
• Ihc-Libertyville Emergency Physicians, LLC

  • Emergency Medicine Physician
  • Libertyville, IL
  • NPI 1053423541

  Physician Assistant

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Aurora Health Care Southern Lakes, Inc.

  • General Acute Care Hospital
  • Kenosha, WI
  • NPI 1225156888
  Care Compare affiliation
• Aurora Health Care Southern Lakes, Inc.

  • General Acute Care Hospital
  • Burlington, WI
  • NPI 1861557753
  Care Compare affiliation

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

{
    "created_epoch": "1499990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669680000000",
    "number": "1750803474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3301 W FOREST HOME AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532152843",
            "telephone_number": "262-948-5600",
            "fax_number": "414-290-6755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10400 75TH ST",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531427884",
            "telephone_number": "262-948-5600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9555 76th St",
            "address_purpose": "LOCATION",
            "city": "Pleasant Prairie",
            "state": "WI",
            "postal_code": "531581984",
            "country_code": "US",
            "telephone_number": "414-290-6720",
            "fax_number": "414-290-6755",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "MATTHEW",
        "middle_name": "D",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-14",
        "last_updated": "2022-11-29",
        "certification_date": "2022-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "4071-23",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mpeterson176231@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "9555 76th St",
            "city": "Pleasant Prairie",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531581984",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mpeterson347622@direct.froedtert.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "9555 76th St",
            "city": "Pleasant Prairie",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531581984",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mpeterson347622@direct.froedtert.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "6308 8th Ave",
            "city": "Kenosha",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531435031",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mpeterson347622@direct.froedtert.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "6308 8th Ave",
            "city": "Kenosha",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531435031",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mpeterson347622@direct.froedtert.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "6308 8th Ave",
            "city": "Kenosha",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531435031",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "9555 76th St",
            "city": "Pleasant Prairie",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531581984",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Chelsey Ruth Peterson
• Craig A. Peterson, D.M.D
• Karen A Peterson, M.D.
• Kristopher Wyllis Peterson, DC
• Mark A Peterson, PA-C
• Tina Anne-Marie Peterson, D.C.
• John D Pettinger, M.D.
• Mary Pettit, RN
• Bethany Pfeiffer
• Elizabeth Pflug-Froh, PT

• Physician Assistant in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.