NPIMap

Individual provider Active NPI

Paul Charles Peterson, MD

  • Vascular Neurology Physician
  • Saint Cloud, MN
National Provider Identifier
1902805518
Registry record updated Apr 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Neurology PhysicianTaxonomy code 2084V0102X
License
64851 Issued in MN
Practice address
1200 6TH Ave N
Saint Cloud, MN 56303-2735
Phone
(320) 255-7891
Fax
(320) 255-5882
NPI assigned
Jul 15, 2005
Last updated
Apr 23, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2020

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 200300395 NC
Vascular Neurology Physician 2084V0102X 200300395 NC
Vascular Neurology Physician 2084V0102X 64851 MN Primary
Sleep Medicine (Psychiatry & Neurology) Physician 2084S0012X 200300395 NC

Addresses

Primary practice location

1200 6TH Ave N
Saint Cloud, MN 56303-2735

Mailing address

1200 6TH Ave N
Saint Cloud, MN 56303-2736
Phone (320) 255-7891

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, MT, CO3 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 3

Enrollment IDStateProvider typePAC IDDetails
I20190709002811 MN Practitioner - NeurologyPractitioner - Emergency Medicine 2668453564 Reassigns benefits to 8 organizations
I20211114000030 MT Practitioner - Neurology 2668453564 Reassigns benefits to 1 organization
I20230207002647 CO Practitioner - Neurology 2668453564 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
University of Texas Medical Branch at Galveston, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Centracare ClinicGroup PAC ID 2466363395, 800 clinicians
St. Luke's Hospital of DuluthGroup PAC ID 7113834839, 409 clinicians

Practice addresses (Care Compare)

1050 Wellington Ave
Imh Wellington Lung and Sleep Clinic
Grand Junction, CO 81501-8121
Phone (970) 298-5864

1200 6TH Ave N
Centracare Clic River Campus
Saint Cloud, MN 56303-2735
Phone (320) 252-5131

915 E 1St St
Duluth, MN 55805-2107
Phone (218) 249-5555

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
200300395NCMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Health System-NR LLC CurrentSince Jun 1, 2022 Accepting new patients
Centracare Clinic Current Accepting new patients
St. Luke's Hospital of Duluth CurrentSince Jan 23, 2024 Accepting new patients
SCL Health Montana Current Accepting new patients
SCL Health Montana CurrentSince Oct 18, 2021 Accepting new patients
St. Luke's Hospital of Duluth CurrentSince Jan 23, 2024 Accepting new patients
Centracare Health System-NR LLC CurrentSince Jun 1, 2022 Accepting new patients
Intermountain Medical Group Grand Junction, LLC CurrentSince Jan 1, 2023 Accepting new patients
Centracare Clinic CurrentSince Aug 1, 2019 Accepting new patients
Centracare Health System - Sauk Centre CurrentSince Jun 1, 2022 Accepting new patients
Centracare Health System-NR LLC Current Accepting new patients
Centracare Health System - Sauk Centre CurrentSince Jun 1, 2022 Accepting new patients
Intermountain Medical Group Grand Junction, LLC CurrentSince Jan 1, 2023 Accepting new patients
Centracare Health System - Sauk Centre Current Accepting new patients
St. Luke's Hospital of Duluth Current Accepting new patients
St. Luke's Hospital of Duluth Current Accepting new patients
SCL Health Montana CurrentSince Oct 18, 2021 Accepting new patients
St. Vincent Healthcare Past Accepting new patients
St. Cloud Hospital Past Accepting new patients
Duke Health Integrated Practice, Inc. Past Accepting new patients
St Mary's Hospital and Medical Center, Inc Past Accepting new patients
Emergency Medicine Physicians of Davidson County, PLLC Emergency Medicine Past Accepting new patients
Accent Urgent Care & After Hours Pediatrics, PA Past Accepting new patients

Locations

500 Eldorado Blvd
Ste 4300
Broomfield, CO 80021

1050 Wellington Ave
Grand Junction, CO 81501
Phone (970) 245-4810

1050 Wellington Ave
Slp Ctr
Grand Junction, CO 81501
Phone (970) 298-5864

750 Wellington Ave
Ste 3A
Grand Junction, CO 81501
Phone (970) 248-3188

29980 Network Pl
Chicago, IL 60673

1015 E 1st St
Duluth, MN 55805
Phone (218) 249-7860

915 E 1st St
Duluth, MN 55805
Phone (218) 249-5352

1013 Hart Blvd
Monticello, MN 55362
Phone (763) 271-2303

1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342

1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422

425 Elm St N
Sauk Centre, MN 56378
Phone (320) 352-2221

325 11th Ave
Two Harbors, MN 55616
Phone (218) 834-5520

1041 N 29th St
Billings, MT 59101
Phone (303) 237-5577

1233 N 30th St
Billings, MT 59101
Phone (406) 237-3850

Interoperability endpoints

  • Direct secure messaging: paul.peterson@slk.direct.slhduluth.com
  • Direct secure messaging: ppeterson237540@direct.aspirus.org
  • Direct secure messaging: ppeterson461618@direct.centracare.com

Organizations & group practices 24

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.

View all 24

Hospital & facility affiliations 38

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1121385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587600000000",
    "number": "1902805518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 6TH AVE N",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563032736",
            "telephone_number": "320-255-7891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 6TH AVE N",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563032735",
            "telephone_number": "320-255-7891",
            "fax_number": "320-255-5882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "PAUL",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-15",
        "last_updated": "2020-04-23",
        "certification_date": "2020-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NC",
            "license": "200300395",
            "primary": false
        },
        {
            "code": "2084V0102X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Vascular Neurology",
            "state": "NC",
            "license": "200300395",
            "primary": false
        },
        {
            "code": "2084V0102X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Vascular Neurology",
            "state": "MN",
            "license": "64851",
            "primary": true
        },
        {
            "code": "2084S0012X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Sleep Medicine",
            "state": "NC",
            "license": "200300395",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

Verify at the official NPI Registry.