Kim A Peterson, DO

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

DO16339 Issued in OR

Practice address

610 NW 11TH St
Hermiston, OR 97838-6601

Phone

(541) 667-3439

Fax

(541) 667-3414

NPI assigned

Jul 4, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

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

Merit-based Incentive Payment System (MIPS)

Final score

77.82 of 100Reported as group

Quality

64.68

Promoting interoperability

100

Improvement activities

40

Cost

47.05

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Good Shepherd Health Care System

  • Critical Access Hospital
  • Hermiston, OR
  • NPI 1295789667
  Medicare reassignment NPD

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1821028960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1724",
            "city": "HERMISTON",
            "state": "OR",
            "postal_code": "978383724",
            "telephone_number": "541-564-9034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 NW 11TH ST",
            "city": "HERMISTON",
            "state": "OR",
            "postal_code": "978386601",
            "telephone_number": "541-667-3439",
            "fax_number": "541-667-3414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "KIM",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OR",
            "license": "DO16339",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "077920",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley Dawn Pearce, PT
• Andrew Scott Pearson, PHARMD
• Toby Allen Penner, CRNA, MSN
• Perfectly Broken LLC
• Julian Petersen, DDS
• Kristopher Bryan Peterson, D.C.
• Twila Dawn Phillips, DIRECTOR
• Physical Medicine & Performance LLC
• Chanty Pin
• Pinnacle Sleep of Oregon

• Emergency Medicine Physician in Hermiston, OR
• Providers in Hermiston, OR by specialty
• Emergency Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.