David Sigurd Petersen, M.D.

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

036055984 Issued in IL

Practice address

2121 1St Street a
Moline, IL 61265-7745

Phone

(309) 764-9790

Fax

(309) 526-8995

NPI assigned

Jan 4, 2007

Last updated

Sep 29, 2021By the provider in NPPES

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

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in IL, IA2 enrollments

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 2

Specialty

Urology

Education

University of Iowa, RJ & L Carver College of Medicine, 1969

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Urological Associates PCGroup PAC ID 7618866815, 16 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Genesis HLTH System Dba Genesis MDL Ctr-Illini Hospital, Silvis, IL, CCN 140275

Merit-based Incentive Payment System (MIPS)

Final score

85.93 of 100Reported as group

Quality

76.66

Promoting interoperability

100

Improvement activities

40

Cost

76.43

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Interoperability endpoints

• Direct secure messaging: david.petersen.p1@direct.urologyqc.nextgenshare.com

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.

• Urological Associates PC

  • Non-Pharmacy Dispensing Site
  • Davenport, IA
  • NPI 1346229192

  IL

  Medicare reassignment Care Compare group
• David S. Petersen, M.D.S.C.

  • Urology Physician
  • Moline, IL
  • NPI 1982900825
  Authorized official Same address or phone

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

• Genesis Health System

  dba Genesis Medical Center - Silvis

  • General Acute Care Hospital
  • Silvis, IL
  • NPI 1427132604
  Care Compare affiliation

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632873600000",
    "number": "1821145590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 1ST STREET A",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612657745",
            "telephone_number": "309-764-9790",
            "fax_number": "309-526-8995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 1ST STREET A",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612657745",
            "telephone_number": "309-764-9790",
            "fax_number": "309-526-8995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "DAVID",
        "middle_name": "SIGURD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-04",
        "last_updated": "2021-09-29",
        "certification_date": "2021-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "IL",
            "license": "036055984",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036055984",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "david.petersen.p1@direct.urologyqc.nextgenshare.com",
            "affiliation": "N",
            "endpointDescription": "Urological Associates PC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "3319 Spring St",
            "city": "Davenport",
            "state": "IA",
            "country_code": "US",
            "postal_code": "528072125",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "david.petersen.p1@direct.urologyqc.nextgenshare.com",
            "affiliation": "N",
            "endpointDescription": "Urological Associates PC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "2121 1st Street A",
            "city": "Moline",
            "state": "IL",
            "country_code": "US",
            "postal_code": "612657745",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• George M. Patramanis, M.D.
• Richard William Payden, MD
• Pediatric Group Associates, SC
• Pediatrics Plus. S.C.
• Marie Therese Perez
• Karen Petersen, CRT
• Tracy Lynn Petersen
• John M Peterson, PHD, MD
• Kyle W. Peterson, DDS
• Rhonda M Peterson, ACNP

• Urology Physician in Moline, IL
• Providers in Moline, IL by specialty
• Urology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 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.

Verify at the official NPI Registry.