NPIMap

Individual provider Active NPI

Glenn A. Petersen, M.D.

  • Family Medicine Physician
  • Albany, OR
National Provider Identifier
1851328645
Registry record updated Nov 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD13466 Issued in OR
Practice address
1700 Geary St SE
Albany, OR 97322-6842
Phone
(541) 812-4550
NPI assigned
Jun 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD13466 OR Primary

Addresses

Primary practice location

1700 Geary St SE
Albany, OR 97322-6842

Mailing address

PO Box 1188
Corvallis, OR 97339-1188

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address gpetersen6305@samhealth.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040709000694 OR Practitioner - Family Practice 8921086646 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Oregon Health Sciences University School of Medicine, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Albany General HospitalGroup PAC ID 9931097987, 191 clinicians

Practice addresses (Care Compare)

1700 Geary St SE
Albany, OR 97322-6842

400 Hickory St NW
Albany, OR 97321-1700

534 Pleasant View Way NW
Albany, OR 97321-1700

705 Elm St SW
Suite 200
Albany, OR 97321-1957
Phone (541) 812-4850

Hospital & facility affiliations

  • Samaritan Albany General Hospital Hospital, Albany, OR, CCN 380022

Merit-based Incentive Payment System (MIPS)

Final score
93.65 of 100Reported as group
Quality
86.8
Promoting interoperability
100
Improvement activities
40
Cost
86.36

Merit-based Incentive Payment System (MIPS)

Final score
94.37 of 100Reported as group
Quality
92.31
Promoting interoperability
100
Improvement activities
40
Cost
80.9

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD13466ORMDFamily Medicine Physician
13466ORMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Albany General Hospital CurrentSince Apr 23, 2012 Accepting new patients
Mid-Valley Healthcare, Inc. CurrentSince Jan 15, 2012 Accepting new patients
Mid-Valley Healthcare Inc CurrentSince Jan 15, 2012 Accepting new patients
Good Samaritan Hospital Corvallis CurrentSince Oct 1, 2012 Accepting new patients
Good Samaritan Hospital Corvallis CurrentSince Oct 1, 2012 Accepting new patients
Mid-Valley Healthcare Inc Current Accepting new patients
Albany General Hospital Current Accepting new patients
Albany General Hospital Family Medicine CurrentSince Apr 23, 2012 Accepting new patients
Good Samaritan Hospital Corvallis Current Accepting new patients
Good Samaritan Hospital Corvallis Past Accepting new patients
Firstcare Medical Foundation Family Medicine PastSince Sep 1, 2004 Accepting new patients

Locations

1100 7th Ave SW
Albany, OR 97321
Phone (541) 812-4970

705 Elm St SW
Ste 200
Albany, OR 97321
Phone (541) 812-4850

1700 Geary St SE
Albany, OR 97322
Phone (541) 812-5500

1086 7th Ave SW
Ste 101
Albany, OR 97321
Phone (541) 812-3349

3600 NW Samaritan Dr
Ste 227
Corvallis, OR 97330
Phone (541) 768-1261

425 N Santiam Hwy
Lebanon, OR 97355
Phone (541) 451-6960

325 Park St
Lebanon, OR 97355
Phone (541) 451-7200

Organizations & group practices 11

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.

Hospital & facility affiliations 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604361600000",
    "number": "1851328645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1188",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973391188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 GEARY ST SE",
            "city": "ALBANY",
            "state": "OR",
            "postal_code": "973226842",
            "telephone_number": "541-812-4550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "GLENN",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-27",
        "last_updated": "2020-11-03",
        "certification_date": "2020-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD13466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gpetersen6305@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "1700 Geary St SE",
            "city": "Albany",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973226842",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Albany, OR

Sources for this page

Verify at the official NPI Registry.