NPIMap

Individual provider Active NPI

Grant E Peterson, MD

  • Internal Medicine Physician
  • Ankeny, IA
National Provider Identifier
1881905370
Registry record updated Oct 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD-41575 Issued in IA
Practice address
2515 SW State St
Ste 100
Ankeny, IA 50023-7079
Phone
(515) 964-6929
NPI assigned
Jun 29, 2010
Last updated
Oct 13, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 6336 NE
Internal Medicine Physician 207R00000X MD-41575 IA Primary

Addresses

Primary practice location

2515 SW State St
Ste 100
Ankeny, IA 50023-7079

Mailing address

2515 SW State St
Ste 100
Ankeny, IA 50023-7079
Phone (515) 964-6929

Other identifiers 2

IdentifierTypeStateIssuer
P01353680OtherIARR MEDICARE
1881905370MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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
I20140711002018 IA Practitioner - Internal Medicine 4587808142 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Iowa, RJ & L Carver College of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1200 Pleasant St
Des Moines, IA 50309-1406
Phone (515) 241-6212

1221 Pleasant St
Des Moines, IA 50309-1424

2720 8TH St SW
Altoona, IA 50009-1028
Phone (515) 967-0133

4480 Utica Ridge Rd
Bettendorf, IA 52722-1644

4480 Utica Ridge Rd
Suite 160
Bettendorf, IA 52722-1637
Phone (563) 742-5950

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
6336NEMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke's Methodist Hospital Current Accepting new patients
Iowa Physicians Clinic Medical Foundation Internal Medicine CurrentSince Jul 28, 2014 Accepting new patients
Central Iowa Hospital Corporation Past Accepting new patients
Trinity Medical Center Internal Medicine Past Accepting new patients

Locations

2515 SW State St
Ste 100
Ankeny, IA 50023
Phone (515) 964-6929

3625 N Ankeny Blvd
Ste E
Ankeny, IA 50023
Phone (515) 965-4664

4480 Utica Ridge Rd
Ste 160
Bettendorf, IA 52722
Phone (563) 742-5950

4480 Utica Ridge Rd
Ste 2230
Bettendorf, IA 52722
Phone (563) 742-5150

Interoperability endpoints

  • Direct secure messaging: gpeterson199363@direct.unitypoint.org

Organizations & group practices 4

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 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": "1277769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413158400000",
    "number": "1881905370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2515 SW STATE ST",
            "address_2": "STE 100",
            "city": "ANKENY",
            "state": "IA",
            "postal_code": "500237079",
            "telephone_number": "515-964-6929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2515 SW STATE ST",
            "address_2": "STE 100",
            "city": "ANKENY",
            "state": "IA",
            "postal_code": "500237079",
            "telephone_number": "515-964-6929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "GRANT",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-29",
        "last_updated": "2014-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NE",
            "license": "6336",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IA",
            "license": "MD-41575",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P01353680",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881905370",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ankeny, IA

Sources for this page

Verify at the official NPI Registry.