Timothy K. Peterson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA02080 Issued in TX

Practice address

2891 E Grant St
Roma, TX 78584

Phone

(956) 849-2100

NPI assigned

Oct 19, 2006

Last updated

Aug 31, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI, TX2 enrollments

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Patient One Care, PLLC

  • Urgent Care Clinic/Center
  • Grand Rapids, MI
  • NPI 1770934325
  Medicare reassignment NPD (past)
• Patient One Care PLLC

  dba AFC Urgent Care

  • Urgent Care Clinic/Center
  • Jenison, MI
  • NPI 1255178695
  NPD
• Spectrum Health Hospitals

  dba Corewell Health Grand Rapids Hospitals Urgent Care

  • Urgent Care Clinic/Center
  • Grand Rapids, MI
  • NPI 1598712390
  NPD (past)

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535673600000",
    "number": "1992887376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 N CHARCO BLANCO RD APT C",
            "city": "RIO GRANDE CITY",
            "state": "TX",
            "postal_code": "785823088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2891 E GRANT ST",
            "city": "ROMA",
            "state": "TX",
            "postal_code": "78584",
            "telephone_number": "956-849-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "TIMOTHY",
        "middle_name": "K.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2018-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA02080",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Keila Pena
• Sara Pena
• Leobardo Perez, COTA
• Performance Therapeutics - Roma PLLC
• Performance Therapeutics - Roma, P.L.L.C.
• R & R Starr Amigos LLC (Popular Pharmacy 3)
• R & R Starr Amigos LLC (Popular Pharmacy # 3)
• Desi Ramos
• Raymond P Mussett MD PLLC (Roma Medical Clinic)
• Raymond P Mussett MD PLLC (Roma Medical Clinic)

• Physician Assistant in Roma, TX
• Providers in Roma, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.