Pamela Marjorie Peterson, PHD, LP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP3975 Issued in MN

Practice address

300 W Broadway
Ste 1
Plainview, MN 55964-1256

Phone

(507) 421-1064

Fax

(507) 932-8556

NPI assigned

Nov 11, 2006

Sex

Female

Sole proprietor

Yes

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.

• Activept Corp

  • Physical Therapy Clinic/Center
  • Rochester, MN
  • NPI 1124205604
  NPD (past)

Specialty

Clinical Psychologist

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 11, 2019.

{
    "created_epoch": "1163203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554940800000",
    "number": "1972674091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 DEVIN DR",
            "city": "SAINT CHARLES",
            "state": "MN",
            "postal_code": "559721701",
            "telephone_number": "507-421-1064",
            "fax_number": "507-523-3661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 W BROADWAY",
            "address_2": "STE 1",
            "city": "PLAINVIEW",
            "state": "MN",
            "postal_code": "559641256",
            "telephone_number": "507-421-1064",
            "fax_number": "507-932-8556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "PAMELA",
        "middle_name": "MARJORIE",
        "name_prefix": "Dr.",
        "credential": "PHD, LP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-11",
        "last_updated": "2019-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP3975",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "607316600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lisa Ann McCabe-Evans, NP-C
• Michelle Lea McMahan
• Susan Kay Myer, LPN
• Carter Nelson
• Melissa Sue Nevsimal, D.C.
• Plainview Dental
• Plainview-Elgin-Millville Community School
• Quiram Dental, PSC
• Paul J Quiram, DDS
• Jeffrey Ramey, RN

• All providers in Plainview, MN
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 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.