Individual provider Active NPI

Erin Kathleen Petersen, MD

  • Dermatology Physician
  • Chicago, IL
National Provider Identifier
1952663098
Registry record updated Apr 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
036-141471 Issued in IL
Practice address
331 W Surf St Ste 700
Chicago, IL 60657-0083
Phone
(773) 832-7443
Fax
(773) 295-4126
NPI assigned
Jun 14, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 036-141471 IL Primary

Addresses

Primary practice location

331 W Surf St Ste 700
Chicago, IL 60657-0083

Mailing address

801 York St
Manitowoc, WI 54220-4630
Phone (920) 663-9008

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address epetersen@cpderm.emadirect.md

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160830001177 IL Practitioner - Dermatology 0941502397 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
University of Missouri, Kansas City, School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Forefront Dermatology SCGroup PAC ID 3779471701, 650 clinicians

Practice addresses (Care Compare)

331 W Surf St
Suite 700
Chicago, IL 60657-0083
Phone (773) 832-7443

Merit-based Incentive Payment System (MIPS)

Final score
97.45 of 100Reported as group
Promoting interoperability
97
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision20
Removal of skin lesions515
Removal or shaving of skin growth1-10
Skin biopsy195

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-141471ILMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Forefront Dermatology, S.C. Dermatology CurrentSince Oct 21, 2024 Accepting new patients
Forefront Dermatology, S.C. Dermatology Current Accepting new patients
Forefront Dermatology, S.C. Dermatology CurrentSince Oct 21, 2024 Accepting new patients
Forefront Dermatology, S.C. Dermatology Past Accepting new patients
Physicians Dermpath Laboratory Past Accepting new patients

Locations

331 W Surf St
Ste 700
Chicago, IL 60657
Phone (773) 832-7443

2051 Plainfield Rd
Crest Hill, IL 60403
Phone (815) 730-9900

801 York St
Manitowoc, WI 54220
Phone (866) 630-9882

Interoperability endpoints

  • Direct secure messaging: epetersen@cpderm.emadirect.md

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1339632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775001600000",
    "number": "1952663098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 YORK ST",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542204630",
            "telephone_number": "920-663-9008",
            "fax_number": "920-684-1439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "331 W SURF ST STE 700",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606570083",
            "telephone_number": "773-832-7443",
            "fax_number": "773-295-4126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "ERIN",
        "middle_name": "KATHLEEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-14",
        "last_updated": "2026-04-01",
        "certification_date": "2026-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IL",
            "license": "036-141471",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "epetersen@cpderm.emadirect.md",
            "affiliation": "N",
            "address_1": "331 W Surf St Ste 700",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606570083",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.