NPIMap

Individual provider Active NPI

Andrew Joseph Peterson, MD

  • Family Medicine Physician
  • Fulton, MO
National Provider Identifier
1952783698
Registry record updated Nov 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036145425 Issued in IL
Practice address
110 N Hospital Dr
Fulton, MO 65251-2511
Phone
(573) 642-5911
Fax
(573) 642-3015
NPI assigned
Jun 18, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 25, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036145425 IL Primary
Family Medicine Physician 207Q00000X 2015019323 MO

Addresses

Primary practice location

110 N Hospital Dr
Fulton, MO 65251-2511

Mailing address

1 Hospital Dr
Columbia, MO 65212-1000
Phone (573) 884-2912

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180726000254 IL Practitioner - Family Practice 4981916509 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osf Healthcare SystemGroup PAC ID 4284541806, shared by 34 NPIs, 94 clinicians
Kewanee HospitalGroup PAC ID 4789578063, 26 clinicians

Practice addresses (Care Compare)

1051 W S St
Kewanee, IL 61443-8354
Phone (309) 852-7500

535 Park Ave E
Princeton, IL 61356-2537
Phone (815) 875-4531

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036145425ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Osf Healthcare System CurrentSince Jan 31, 2022 Accepting new patients
Osf Healthcare System CurrentSince Aug 15, 2018 Accepting new patients
Osf Multi-Specialty Group CurrentSince Jul 22, 2019 Accepting new patients
Osf Healthcare System Current Accepting new patients
Osf Healthcare System CurrentSince Aug 15, 2018 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients

Locations

230 Exchange St
Galva, IL 61434

1051 W South St
Kewanee, IL 61443
Phone (309) 734-3141

1000 W Harlem Ave
Monmouth, IL 61462
Phone (309) 734-1414

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

535 Park Ave E
Princeton, IL 61356
Phone (815) 875-4531

Organizations & group practices 6

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.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1434585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764028800000",
    "number": "1952783698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 HOSPITAL DR",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652121000",
            "telephone_number": "573-884-2912",
            "fax_number": "573-884-7060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 N HOSPITAL DR",
            "city": "FULTON",
            "state": "MO",
            "postal_code": "652512511",
            "telephone_number": "573-642-5911",
            "fax_number": "573-642-3015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "ANDREW",
        "middle_name": "JOSEPH",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-06-18",
        "last_updated": "2025-11-25",
        "certification_date": "2025-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036145425",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2015019323",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fulton, MO

Sources for this page

Verify at the official NPI Registry.