Travis Scott Petersen, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

4351050607 Issued in MI

Practice address

1500 E Medical Center Dr # TC-B1380
Ann Arbor, MI 48109-5000

Phone

(734) 936-6666

NPI assigned

Jun 16, 2023

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 MI

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1686873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686873600000",
    "number": "1861177073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 E MEDICAL CENTER DR # TC-B1-380",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481095305",
            "telephone_number": "734-936-6666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 E MEDICAL CENTER DR # TC-B1380",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481095000",
            "telephone_number": "734-936-6666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "TRAVIS",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-16",
        "last_updated": "2023-06-16",
        "certification_date": "2023-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "4351050607",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Meredith Duran Peters, M.D.
• Sydney Marie Peters, MD
• Ketti Sophia Petersen, MD
• McKayla Petersen, BSN RN
• Taylor Petersen, PA
• Carol Jean Peterson, RN, BSN
• Edwin Peter Peterson, MD
• Leah Claire Peterson, PA-C
• Marissa Peterson
• Rochelle C Peterson, MA CCC-SLP

• Emergency Medicine Physician in Ann Arbor, MI
• Providers in Ann Arbor, MI by specialty
• Emergency Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.