Brayden Petersen, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

ODP100472 Issued in ID

Practice address

307 S 1St Ave
Sandpoint, ID 83864-1201

Phone

(208) 263-8501

NPI assigned

Jun 5, 2019

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

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Pacific University - College of Optometry, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eye Clinic of Sandpoint PAGroup PAC ID 3678541018, 2 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Quality

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Eye Clinic of Sandpoint PA

  • Ophthalmology Physician
  • Sandpoint, ID
  • NPI 1215945431

  Optometrist

  Medicare reassignment Care Compare group NPD
• Eye Clinic of Sandpoint PA

  • Eyewear Supplier
  • Sandpoint, ID
  • NPI 1104957612
  NPD (past)

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

{
    "created_epoch": "1559692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565222400000",
    "number": "1932767753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 S 1ST AVE",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838641201",
            "telephone_number": "208-263-8501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 S 1ST AVE",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838641201",
            "telephone_number": "208-263-8501"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1720 N Hamilton St",
            "address_purpose": "LOCATION",
            "city": "Spokane",
            "state": "WA",
            "postal_code": "992072474",
            "country_code": "US",
            "telephone_number": "509-328-2632",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "513 E Hastings Rd Ste C",
            "address_purpose": "LOCATION",
            "city": "Spokane",
            "state": "WA",
            "postal_code": "992181977",
            "country_code": "US",
            "telephone_number": "509-328-2632",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "BRAYDEN",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-05",
        "last_updated": "2019-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD60970822",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP100472",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pennyfarthing LLC
• Percussionaire Corporation
• Shannon Marie Perkins Baker, LMSW
• Barbara Perusse, LCPC
• Catherine Perusse, LPC
• Jason Petersen, O.D.
• Alexandria Nicole Peterson, RDN
• Suzanne Peyser
• Erin Phillips, LMT
• Jordyn Leeann Phillips, OTR/L

• Optometrist in Sandpoint, ID
• Providers in Sandpoint, ID by specialty
• Optometrist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2019; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.