Active NPI
William G. Petersen, M.D.
- Pulmonary Disease Physician
- Amarillo, TX
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pulmonary Disease Physician
- License
- G5477
- Practice address
- 1600 Wallace Blvd
Amarillo, TX 79106-1799 - Phone
- (806) 212-2129
- Fax
- (806) 212-2246
- NPI assigned
- Mar 31, 2006
- Last updated
- May 18, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pulmonary Disease Physician | 207RP1001X | G5477 | TX | Primary |
Addresses
Primary practice location
1600 Wallace Blvd
Amarillo, TX 79106-1799
Mailing address
PO Box 840026
Dallas, TX 75284-0026
Phone (254) 724-2111
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 101087805 | Medicaid | TX | |
| 733996 | Other | TX | MEDICARE ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Pulmonary Disease
- Education
- University of Missouri, Columbia School of Medicine, 1982
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1600 Wallace Blvd
Amarillo, TX 79106-1799
Phone (806) 212-2129
1751 Wallace Blvd
Amarillo, TX 79106-1711
Phone (806) 359-4673
Hospital & facility affiliations
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Upper gastrointestinal (GI) endoscopy for acid reflux | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G5477 | TX | MD | Pulmonary Disease Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Christus Trinity Clinic Texas | Current | Accepting new patients | |
| Christus Trinity Clinic Texas | Current | Accepting new patients | |
| Bsa Physicians Group Inc | Current | Accepting new patients | |
| Bsa Physicians Group Inc | Current | Accepting new patients |
Locations
1600 Wallace Blvd
Amarillo, TX 79106
Phone (806) 212-2000
1751 Wallace Blvd
Amarillo, TX 79106
Phone (806) 212-2129
630 S Fleishel Ave
Tyler, TX 75701
Phone (903) 510-8888
800 E Dawson St
Tyler, TX 75701
Phone (903) 531-5018
Interoperability endpoints
- wpetersen174466@christushealth.direct-ci.net
- wpetersen182084@ahs.direct-ci.com
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Internal Medicine Physician
- Amarillo, TX
- NPI 1457696916
-
dba Christus Trinity Clinic
- Family Medicine Physician
- Tyler, TX
- NPI 1285684225
-
dba Baptist St. Anthony's Urgent Care Clinic
- Family Medicine Physician
- Amarillo, TX
- NPI 1144668765
-
dba Christus Trinity Clinic
- Rural Health Clinic/Center
- Winnsboro, TX
- NPI 1801673165
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Amarillo, TX
- NPI 1407191984
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143763200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621296000000",
"number": "1770544579",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 840026",
"city": "DALLAS",
"state": "TX",
"postal_code": "752840026",
"telephone_number": "254-724-2111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 WALLACE BLVD",
"city": "AMARILLO",
"state": "TX",
"postal_code": "791061799",
"telephone_number": "806-212-2129",
"fax_number": "806-212-2246"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSEN",
"first_name": "WILLIAM",
"middle_name": "G.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-31",
"last_updated": "2021-05-18",
"certification_date": "2021-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "207RP1001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Pulmonary Disease",
"state": "TX",
"license": "G5477",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "101087805",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE ID",
"identifier": "733996",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Amarillo, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2021; 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.