NPIMap

Individual provider Active NPI

Wendy Peterson, PA

  • Physician Assistant
  • Rapid City, SD
National Provider Identifier
1891786166
Registry record updated Jan 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1004 Issued in SD
Practice address
1730 Haines Ave
Rapid City, SD 57701-0615
Phone
(605) 721-4934
Fax
(605) 791-7704
NPI assigned
Nov 4, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 3581 GA
Physician Assistant 363A00000X 2991 OK
Physician Assistant 363A00000X 1004 SD Primary

Addresses

Primary practice location

1730 Haines Ave
Rapid City, SD 57701-0615

Mailing address

PO Box 817
Rapid City, SD 57709-0817
Phone (605) 721-4934

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD, OK2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20161017001405 SD Practitioner - Physician Assistant 4183618309 Reassigns benefits to 1 organization
I20190211000225 OK Practitioner - Physician Assistant 4183618309 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Fusion MD PLLC 6 clinicians

Practice addresses (Care Compare)

5472 Main St
Suite 101
Del City, OK 73115-5524
Phone (405) 622-3699

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
003581GAMDRegistered Dietitian
3581GAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Hospital Logan County, Inc CurrentSince Mar 11, 2019 Accepting new patients
Board of Regents of the University of Oklahoma - Ou Physicians CurrentSince May 3, 2019 Accepting new patients
Privia Medical Group of Georgia LLC CurrentSince Mar 28, 2017 Accepting new patients
Ou Health Partners, Inc CurrentSince Jul 1, 2021 Accepting new patients
Black Hills Surgical Hospital, LLC CurrentSince Aug 31, 2016 Accepting new patients
Black Hills Surgical Hospital, LLC Current Accepting new patients
Board of Regents of the University of Oklahoma - Ou Physicians CurrentSince May 3, 2019 Accepting new patients
Black Hills Surgical Hospital, LLC CurrentSince Aug 31, 2016 Accepting new patients
Piedmont Providers LLC Past Accepting new patients

Locations

101 Yorktown Dr
Ste 100
Fayetteville, GA 30214
Phone (770) 460-4285

200 S Academy Rd
Guthrie, OK 73044
Phone (405) 260-4165

825 NE 10th St
Oklahoma City, OK 73104
Phone (405) 271-4864

900 NE 10th St
Oklahoma City, OK 73104
Phone (405) 271-2230

1730 Haines Ave
Rapid City, SD 57701
Phone (605) 791-7788

216 Anamaria Dr
Rapid City, SD 57701
Phone (605) 388-9440

Interoperability endpoints

  • Direct secure messaging: wendy.peterson.1@17618.direct.athenahealth.com
  • Direct secure messaging: wendy.peterson@35659640274948.direct.elationemr.com

Organizations & group practices 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1131062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548028800000",
    "number": "1891786166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 817",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577090817",
            "telephone_number": "605-721-4934",
            "fax_number": "605-791-7704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1730 HAINES AVE",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577010615",
            "telephone_number": "605-721-4934",
            "fax_number": "605-791-7704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "WENDY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-04",
        "last_updated": "2019-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "3581",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "2991",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SD",
            "license": "1004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rapid City, SD

Sources for this page

Verify at the official NPI Registry.