NPIMap

Individual provider Active NPI

Michael C Peterson, PA-C

  • Physician Assistant
  • Mentor, OH
National Provider Identifier
1861542086
Registry record updated Mar 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50002538 Issued in OH
Practice address
LHPG Mentor Family Practice
8655 Market Street
Mentor, OH 44060
Phone
(440) 255-7938
Fax
(440) 255-9196
NPI assigned
Jan 11, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 50002538 OH Primary

Addresses

Primary practice location

LHPG Mentor Family Practice
8655 Market Street
Mentor, OH 44060

Mailing address

8655 Market Street
Mentor, OH 44060-9404
Phone (440) 255-7938

Other practice location 1

5266 State Route 45
Rome, OH 44085-9404
Phone (440) 563-5028

Other identifiers 1

IdentifierTypeStateIssuer
50.002538OtherOHOHIO LICENSE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address michael.peterson@lhpg.eclinicaldirectplus.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20110125001297 OH Practitioner - Physician Assistant 7113106998 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lake Hospital System, Inc.Group PAC ID 6002713922, 92 clinicians

Practice addresses (Care Compare)

36500 Euclid Ave
Willoughby, OH 44094-4455
Phone (440) 516-0530

8655 Market St
Mentor, OH 44060-4112
Phone (440) 255-6400

Hospital & facility affiliations

  • Lake Health Hospital, Concord, OH, CCN 360098
  • Uh Cleveland Medical Center Hospital, Cleveland, OH, CCN 360137

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
50002538OHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Hospital System, Inc CurrentSince Sep 24, 2018 Accepting new patients
Lake Hospital System Inc CurrentSince Sep 24, 2018 Accepting new patients
Primary Health Network Current Accepting new patients
Lake Hospital System, Inc Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

5594 State Route 7
Andover, OH 44003
Phone (440) 293-2444

7590 Auburn Rd
Ste 14
Concord Township, OH 44077
Phone (440) 354-1899

8655 Market St
Mentor, OH 44060
Phone (440) 255-6400

8655 Market St
Ste 200
Mentor, OH 44060
Phone (440) 255-7938

10780 Kinsman Rd
Newbury, OH 44065
Phone (440) 564-5656

100 Shenango Ave
Sharon, PA 16146
Phone (724) 704-8886

63 Pitt St
Sharon, PA 16146
Phone (724) 342-6604

Interoperability endpoints

  • Direct secure messaging: mpeterson28425@ehrdirect.uhhospitals.org

Organizations & group practices 6

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 5

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

NPI Registry JSON

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614556800000",
    "number": "1861542086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8655 MARKET STREET",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440609404",
            "telephone_number": "440-255-7938",
            "fax_number": "440-255-9196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "LHPG MENTOR FAMILY PRACTICE",
            "address_2": "8655 MARKET STREET",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "44060",
            "telephone_number": "440-255-7938",
            "fax_number": "440-255-9196"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5266 State Route 45",
            "address_purpose": "LOCATION",
            "city": "Rome",
            "state": "OH",
            "postal_code": "440859404",
            "country_code": "US",
            "telephone_number": "440-563-5028",
            "fax_number": "440-563-3044",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "MICHAEL",
        "middle_name": "C",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-11",
        "last_updated": "2021-03-01",
        "certification_date": "2021-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50002538",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OHIO LICENSE",
            "identifier": "50.002538",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "michael.peterson@lhpg.eclinicaldirectplus.com",
            "affiliation": "N",
            "endpointDescription": "Baseline West Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "LHPG Mentor Family Practice",
            "address_2": "8655 Market Street",
            "city": "Mentor",
            "state": "OH",
            "country_code": "US",
            "postal_code": "44060",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mentor, OH

Sources for this page

Verify at the official NPI Registry.