Chris Albert Petersen, PAC

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA00211 Issued in OR

Practice address

875 Oak St SE
Suite 5020
Salem, OR 97301-3975

Phone

(503) 226-6321

Fax

(503) 227-3422

NPI assigned

Aug 22, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• The Oregon Clinic PC

  • Specialist
  • Portland, OR
  • NPI 1265417174
  NPD (past)
• The Oregon Clinic, PC

  • Durable Medical Equipment & Medical Supplies
  • Portland, OR
  • NPI 1346105129
  NPD (past)

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

{
    "created_epoch": "1124668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1250640000000",
    "number": "1952393241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "975 SE SANDY BLVD",
            "address_2": "SUITE 200",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972141308",
            "telephone_number": "503-963-2846",
            "fax_number": "503-963-9505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 OAK ST SE",
            "address_2": "SUITE 5020",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973013975",
            "telephone_number": "503-226-6321",
            "fax_number": "503-227-3422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "CHRIS",
        "middle_name": "ALBERT",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-22",
        "last_updated": "2009-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OR",
            "license": "PA00211",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "210476",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8435877",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lisa Rene Peters, NP-C
• Rachel Peters
• Theresa Louise Peters, LCSW
• Jordan Peterschmidt, DMD
• Barbara Jacqueline Petersen, PT
• Rocio Petersen, MS, RDN
• Savanah Danielle Marie Petersen, MSW
• Peterson Chiropractic Clinic
• Abigail Quinn Lindsey Peterson, CPM
• Amara Lenore Peterson

• Surgical Physician Assistant in Salem, OR
• Providers in Salem, OR by specialty
• Surgical Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.