Active NPI
Matthew James Petersen, M.D.
- Diagnostic Radiology Physician
- Indianapolis, IN
National Provider Identifier
1972767556
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 01069464A
- Practice address
- 1701 N Senate Blvd
Radiology Dept
Indianapolis, IN 46202-1239 - Phone
- (317) 962-5740
- NPI assigned
- Jul 14, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 11013619A | IN | |
| Diagnostic Radiology Physician | 2085R0202X | 01069464A | IN | Primary |
Addresses
Primary practice location
1701 N Senate Blvd
Radiology Dept
Indianapolis, IN 46202-1239
Mailing address
714 N Senate Ave
Ste 100
Indianapolis, IN 46202-3763
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201027110 | Medicaid | IN | |
| P00966874 | Other | IN | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Diagnostic Radiology
- Education
- Wayne State University School of Medicine, 2006
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1223 Gateway Dr
Melbourne, FL 32901-2607
Phone (321) 725-4500
1350 Hickory St
Melbourne, FL 32901-3224
Phone (321) 434-7000
Hospital & facility affiliations
- Holmes Regional Medical Center
- Viera Hospital
- Cape Canaveral Hospital
- Palm Bay Hospital
- Parrish Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 75 of 100
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11013619A | IN | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brevard Physician Associates, PLLC | Diagnostic Radiology | Current | Accepting new patients |
| Health First Medical Group, LLC | Diagnostic Radiology | Current | Accepting new patients |
| Health First Medical Group, LLC | Current | Accepting new patients |
Locations
699 W Cocoa Beach Cswy
Ste 405
Cocoa Beach, FL 32931
Phone (321) 868-7272
1350 Hickory St
Melbourne, FL 32901
Phone (321) 434-1771
1223 Gateway Dr
Melbourne, FL 32901
Phone (321) 549-0677
3300 S Fiske Blvd
Rockledge, FL 32955
Phone (321) 434-1771
Interoperability endpoints
- mpetersen71353@epicdirect.hf.org
Organizations & group practices 3
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.
-
- Anesthesiology Physician
- Melbourne, FL
- NPI 1598008955
Diagnostic Radiology
-
- General Practice Physician
- Melbourne, FL
- NPI 1750626495
Diagnostic Radiology
-
- General Practice Physician
- Rockledge, FL
- NPI 1073268934
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Cocoa Beach, FL
- NPI 1184691610
-
- General Acute Care Hospital
- Palm Bay, FL
- NPI 1386940823
-
- General Acute Care Hospital
- Melbourne, FL
- NPI 1295702728
-
- General Acute Care Hospital
- Titusville, FL
- NPI 1053424648
-
- General Acute Care Hospital
- Melbourne, FL
- NPI 1730494816
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215993600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319760000000",
"number": "1972767556",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "714 N SENATE AVE",
"address_2": "STE 100",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462023763"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1701 N SENATE BLVD",
"address_2": "RADIOLOGY DEPT",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462021239",
"telephone_number": "317-962-5740"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSEN",
"first_name": "MATTHEW",
"middle_name": "JAMES",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-07-14",
"last_updated": "2011-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "IN",
"license": "11013619A",
"primary": false
},
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "IN",
"license": "01069464A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "201027110",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00966874",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2011; 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.