Alexander David Pederson, MD

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

036-124938 Issued in IL

Practice address

211 S 3Rd St
Dept of Pathology
Belleville, IL 62220-1915

Phone

(618) 234-2120

Fax

(618) 222-4630

NPI assigned

Aug 24, 2006

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 IA

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

Specialty

Pathology

Education

University of Nebraska College of Medicine, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southeast Iowa Regional Medical Center IncGroup PAC ID 3870496417, 259 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Southeast Iowa Regional Medical Center Hospital, West Burlington, IA, CCN 160057
• University of Iowa Hospital & Clinics Hospital, Iowa City, IA, CCN 160058
• Henry County Health Center Hospital, Mount Pleasant, IA, CCN 161356

Merit-based Incentive Payment System (MIPS)

Final score

77.06 of 100Reported as group

Quality

64.36

Promoting interoperability

81

Improvement activities

40

Cost

75.01

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Southeast Iowa Regional Medical Center, Inc.

  dba Southeast Iowa Regional Medical Center

  • General Practice Physician
  • West Burlington, IA
  • NPI 1164433884
  Medicare reassignment Care Compare group NPD
• Henry County Health Center Inc

  • General Practice Physician
  • Mt Pleasant, IA
  • NPI 1871177477
  Medicare reassignment NPD
• Henry County Health Center, Inc.

  • Critical Access Hospital
  • Mt Pleasant, IA
  • NPI 1811571417
  Medicare reassignment NPD
• Creighton University

  dba Creighton Medical Associates

  • Allergy & Immunology (Internal Medicine) Physician
  • Omaha, NE
  • NPI 1295777225

  Anatomic Pathology & Clinical Pathology

  NPD (past)
• Creighton University

  dba Creighton Therapy and Wellness

  • Physical Therapist
  • Omaha, NE
  • NPI 1780172304
  NPD (past)

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

• Henry County Health Center, Inc.

  • Critical Access Hospital
  • Mt Pleasant, IA
  • NPI 1811571417
  Care Compare affiliation
• Southeast Iowa Regional Medical Center, Inc.

  dba Southeast Iowa Regional Medical Center

  • General Acute Care Hospital
  • West Burlington, IA
  • NPI 1134168263
  Care Compare affiliation
• State University of Iowa

  dba University of Iowa Health Care Medical Center

  • General Acute Care Hospital
  • Iowa City, IA
  • NPI 1376544320
  Care Compare affiliation

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334534400000",
    "number": "1841307899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 144333",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328144333",
            "telephone_number": "407-422-9831",
            "fax_number": "407-206-1767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 S 3RD ST",
            "address_2": "DEPT OF PATHOLOGY",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622201915",
            "telephone_number": "618-234-2120",
            "fax_number": "618-222-4630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSON",
        "first_name": "ALEXANDER",
        "middle_name": "DAVID",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-24",
        "last_updated": "2012-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "IL",
            "license": "036-124938",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• PC Associates, LLC
• PC Associates, LLC
• PCS Mso, LLC
• Peace Harmony & Dignity LLC
• Chris Jay Pearsall
• Bridgette L Peek, CRNA
• Gwendolyn C Pelate, CNA
• Pete L Pelletier, M.D.
• Ebony Sharette Penn
• Rickie W. Penny, D.M.D.

• Anatomic Pathology & Clinical Pathology Physician in Belleville, IL
• Providers in Belleville, IL by specialty
• Anatomic Pathology & Clinical Pathology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2012; 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.