Marlisa S Peterson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

325 W Liberty St
Sumter, SC 29150-5139

Phone

(803) 774-7000

Fax

(803) 774-7004

NPI assigned

Nov 10, 2014

Sex

Female

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 SC, AL2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Cedars Medical Clinic PA

  • Public Health or Welfare Agency
  • Sumter, SC
  • NPI 1578580395
  Medicare reassignment

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

{
    "created_epoch": "1415577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415577600000",
    "number": "1891191409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 W LIBERTY ST",
            "city": "SUMTER",
            "state": "SC",
            "postal_code": "291505139",
            "telephone_number": "803-774-7000",
            "fax_number": "803-774-7004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 W LIBERTY ST",
            "city": "SUMTER",
            "state": "SC",
            "postal_code": "291505139",
            "telephone_number": "803-774-7000",
            "fax_number": "803-774-7004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "MARLISA",
        "middle_name": "S",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-11-10",
        "last_updated": "2014-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jalessa Perry
• Personal Care of Sumter Inc
• Brooke Howell Perugini, D.O.
• Bridget Alexandra Peters, DO
• Demair Peterson
• Marissa Pettit
• PH Diabetes Self Care MGT Program
• Phillip L. Latham Jr
• Phillips Pharmacy, Inc.
• Don Allen Phillips

• Physician Assistant in Sumter, SC
• Providers in Sumter, SC by specialty
• Physician Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2014; 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.