Michael Charles Petersen, M.D.

Primary specialty

Pediatric Emergency Medicine (Pediatrics) PhysicianTaxonomy code 2080P0204X

License

Q2049 Issued in TX

Practice address

12356 Riata Trace Pkwy # 6006-B
Austin, TX 78727-6417

Phone

(512) 506-7000

Fax

(314) 251-4450

NPI assigned

Sep 12, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• North County Emergency Physicians, LLP

  • Emergency Medicine Physician
  • Florissant, MO
  • NPI 1356366934
  NPD (past)
• SSM Health Care St. Louis

  • Emergency Medicine Physician
  • Saint Charles, MO
  • NPI 1427002922

  Pediatrics

  NPD (past)
• SSM Health Care St. Louis

  • Emergency Medical Services (Emergency Medicine) Physician
  • Lake St Louis, MO
  • NPI 1538113097

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1158019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567555200000",
    "number": "1881798379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12356 RIATA TRACE PKWY # 6006-B",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787276417",
            "telephone_number": "512-506-7000",
            "fax_number": "314-251-4450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12356 RIATA TRACE PKWY # 6006-B",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787276417",
            "telephone_number": "512-506-7000",
            "fax_number": "314-251-4450"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "621 S New Ballas Rd",
            "address_2": "6006-B",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631418232",
            "country_code": "US",
            "telephone_number": "314-251-6299",
            "fax_number": "314-251-4450",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "MICHAEL",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-12",
        "last_updated": "2019-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2006027561",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "TX",
            "license": "Q2049",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "Austin",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "12356 Riata Trace Pkwy # 6006-B",
            "city": "Austin",
            "state": "TX",
            "country_code": "US",
            "postal_code": "787276417",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "Austin",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "12356 Riata Trace Pkwy # 6006-B",
            "city": "Austin",
            "state": "TX",
            "country_code": "US",
            "postal_code": "787276417",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mary Katharine Peters, D.D.S.
• Sheila Ann Peters, CRNA
• Bethany Anne Petersen, DDS
• Christie Petersen, M.ED., LBA
• Megan Petersen, PT, DPT
• Michael G Petersen, PA-C
• Rosann Petersen, RDN
• Ashley Paige Jordan Peterson Sconzo, AU.D.
• Arthur Darwin Peterson, D.C.
• Betty Peterson, PHD

• Pediatric Emergency Medicine (Pediatrics) Physician in Austin, TX
• Providers in Austin, TX by specialty
• Pediatric Emergency Medicine (Pediatrics) Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.