Active NPI
Nicole Peterson
- Medical Physician Assistant
- Merrillville, IN
National Provider Identifier
1992424048
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 10003571A
- Practice address
- 200 E 89TH Ave Ste 2a
Merrillville, IN 46410-7319 - Phone
- (219) 736-2800
- Fax
- (219) 736-6680
- NPI assigned
- Aug 23, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 10003571A | IN | Primary |
Addresses
Primary practice location
200 E 89TH Ave Ste 2a
Merrillville, IN 46410-7319
Mailing address
200 E 89TH Ave Ste 2a
Merrillville, IN 46410-7319
Phone (219) 736-2800
Other practice location 1
929 Ridge Rd Ste 5
Munster, IN 46321-1769
Phone (219) 836-2000
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | nicole.peterson@premieronchem.gd.direct-ci.com | Health Information Exchange (HIE) | suniti medical corporation |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10003571A | IN | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1661212800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661212800000",
"number": "1992424048",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 E 89TH AVE STE 2A",
"city": "MERRILLVILLE",
"state": "IN",
"postal_code": "464107319",
"telephone_number": "219-736-2800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 E 89TH AVE STE 2A",
"city": "MERRILLVILLE",
"state": "IN",
"postal_code": "464107319",
"telephone_number": "219-736-2800",
"fax_number": "219-736-6680"
}
],
"practiceLocations": [
{
"address_1": "929 Ridge Rd Ste 5",
"address_purpose": "LOCATION",
"city": "Munster",
"state": "IN",
"postal_code": "463211769",
"country_code": "US",
"telephone_number": "219-836-2000",
"fax_number": "219-836-8272",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PETERSON",
"first_name": "NICOLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-08-23",
"last_updated": "2022-08-23",
"certification_date": "2022-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "IN",
"license": "10003571A",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "nicole.peterson@premieronchem.gd.direct-ci.com",
"affiliation": "Y",
"affiliationName": "suniti medical corporation",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "200 E 89th Ave Ste 2A",
"city": "Merrillville",
"state": "IN",
"country_code": "US",
"postal_code": "464107319",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Merrillville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.