NPIMap

Individual provider Active NPI

Kirk C Peterson, MD

  • Anatomic Pathology Physician
  • Twin Falls, ID
National Provider Identifier
1982650131
Registry record updated Oct 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology PhysicianTaxonomy code 207ZP0101X
License
M-7970 Issued in ID
Practice address
801 Pole Line Rd W
Department of Pathology
Twin Falls, ID 83301-5810
Phone
(208) 814-0363
Fax
(208) 814-0911
NPI assigned
May 26, 2006
Last updated
Oct 27, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology Physician 207ZP0101X M-7970 ID Primary

Addresses

Primary practice location

801 Pole Line Rd W
Department of Pathology
Twin Falls, ID 83301-5810

Mailing address

801 Pole Line Rd W
Department of Pathology
Twin Falls, ID 83301-5810

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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
I20120109000423 ID Practitioner - Pathology 6507955440 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Medical College of Georgia School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Valley Pathology Associates PLLCGroup PAC ID 0244329175, 3 clinicians

Practice addresses (Care Compare)

801 Pole Line Rd W
Twin Falls, ID 83301-5810
Phone (208) 814-0361

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.78 of 100Reported as group
Quality
100
Improvement activities
40
Cost
85.93

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Valley Pathology Associates PLLC Anatomic Pathology CurrentSince Jul 1, 2000 Accepting new patients
St Luke's Magic Valley Regional Medical Center LTD Past Accepting new patients

Locations

801 Pole Line Rd W
Twin Falls, ID 83301
Phone (208) 814-1000

Organizations & group practices 2

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.

Hospital & facility affiliations 7

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": "1148601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603756800000",
    "number": "1982650131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 POLE LINE RD W",
            "address_2": "DEPARTMENT OF PATHOLOGY",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 POLE LINE RD W",
            "address_2": "DEPARTMENT OF PATHOLOGY",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015810",
            "telephone_number": "208-814-0363",
            "fax_number": "208-814-0911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "KIRK",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-26",
        "last_updated": "2020-10-27",
        "certification_date": "2020-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0101X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology",
            "state": "ID",
            "license": "M-7970",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Twin Falls, ID

Sources for this page

Verify at the official NPI Registry.