Individual provider Active NPI

Alexa Renee Peterson, DO

  • Emergency Medicine Physician
  • Clarksville, TN
National Provider Identifier
1871171975
Registry record updated Oct 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
5784 Issued in TN
Practice address
651 Dunlop LN
Clarksville, TN 37040-5015
Phone
(931) 502-1000
NPI assigned
Mar 30, 2021
Last updated
Oct 19, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X 5784 TN Primary

Addresses

Primary practice location

651 Dunlop LN
Clarksville, TN 37040-5015

Mailing address

1232 Lighthouse PL
Brentwood, TN 37027-8352

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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

Enrollment IDStateProvider typePAC IDDetails
I20241106002936 TN Practitioner - Emergency Medicine 4082148507 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emergi-TrustGroup PAC ID 3375448699, 17 clinicians
Southeastern Emergency Physicians LLCGroup PAC ID 2466364997, 776 clinicians

Practice addresses (Care Compare)

4321 Carothers Pkwy
Franklin, TN 37067-5909
Phone (781) 280-1640

651 Dunlop LN
Clarksville, TN 37040-5015
Phone (931) 502-1000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Southeastern Emergency Physicians LLC Emergency Medicine CurrentSince Jul 15, 2024 Accepting new patients
Emergi-Trust Emergency Medicine CurrentSince Jan 1, 2026 Accepting new patients

Locations

1325 Highway 76
Clarksville, TN 37043
Phone (615) 788-9324

651 Dunlop Ln
Clarksville, TN 37040
Phone (931) 502-1000

4321 Carothers Pkwy
Franklin, TN 37067
Phone (615) 435-5000

265 Brookview Centre Way
Ste 203
Knoxville, TN 37919
Phone (865) 985-7114

9352 Park West Blvd
Knoxville, TN 37923
Phone (865) 373-1000

Organizations & group practices 2

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.

Hospital & facility affiliations 2

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": "1617062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729296000000",
    "number": "1871171975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1232 LIGHTHOUSE PL",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370278352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "651 DUNLOP LN",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370405015",
            "telephone_number": "931-502-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "ALEXA",
        "middle_name": "RENEE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-30",
        "last_updated": "2024-10-19",
        "certification_date": "2024-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TN",
            "license": "5784",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarksville, TN

Sources for this page

Verify at the official NPI Registry.