Robert A Peterson (NPI# 1629052774, PAC ID# 4688700016) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is INTERNAL MEDICINE.
| Nation Provider ID (NPI) | 1629052774 |
| PAC ID by PECOS | 4688700016 |
| Professional Enrollment ID | I20100324001214 |
| Full Name | Robert A Peterson |
| Organization Legal Name | PARK NICOLLET CLINIC |
| Address |
6000 Earle Brown Dr Brooklyn Center MN 55430-2506 |
| Phone Number | 9529934900 |
| Gender | M |
| Medical School | UNIVERSITY OF MINNESOTA MEDICAL SCHOOL |
| Graduation Year | 1971 |
| Primary Specialty | INTERNAL MEDICINE |
| Group Practice PAC ID | 7911819438 |
| Number of Group Practice Members | 1323 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 240053 | PARK NICOLLET METHODIST HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 5320 Hyland Greens Dr, Bloomington, MN 55437-3934 | 9529932400 | PARK NICOLLET CLINIC |
| 6000 Earle Brown Dr, Brooklyn Center, MN 55430-2506 | 9529934900 | PARK NICOLLET CLINIC |
| Organization Legal Name | PARK NICOLLET CLINIC |
| Physicians | 1272 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Grace Marie Irish | Nurse Practitioner | Park Nicollet Clinic | 3850 Park Nicollet Blvd, St Louis Park, MN 55416-2527 |
| Johanna Dijkstal Beebe | Ophthalmology | Park Nicollet Clinic | 250 Central Ave N, Wayzata, MN 55391-1206 |
| Lonzale Ramsey | Family Medicine | Park Nicollet Clinic | 2001 Blaisdell Ave, Minneapolis, MN 55404-2414 |
| Kurt Wolff | Physical Therapy | Park Nicollet Clinic | 15800 N 95th Ave, Maple Grove, MN 55369-4400 |
| Alexandra E Wells | Internal Medicine | Park Nicollet Clinic | 13688 Rogers Dr, Rogers, MN 55374-4916 |
| Mysoon M Ayuob | Family Medicine | Park Nicollet Clinic | 15111 Twelve Oaks Ctr Dr, Minnetonka, MN 55305-5201 |
| Brian Lee Walters | Orthopedic Surgery | Park Nicollet Clinic | 14000 Fairview Dr, Burnsville, MN 55337-5713 |
| Jared J Mell | Family Medicine | Park Nicollet Clinic | 4951 Excelsior Blvd, St Louis Park, MN 55416-3033 |
| Sean M Reardon | Clinical Psychologist | Park Nicollet Clinic | 9555 Upland N Ln, Maple Grove, MN 55369-4485 |
| Jeffrey J Mohr | Physician Assistant | Park Nicollet Clinic | 1885 Plaza Dr, Eagan, MN 55122-2979 |
| Street Address |
6000 EARLE BROWN DR |
| City | BROOKLYN CENTER |
| State | MN |
| Zip | 55430-2506 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Patricia L Haroldson | Certified Nurse Midwife (cnm) | Park Nicollet Clinic | 6000 Earle Brown Dr, Brooklyn Center, MN 55430-2506 |
| Vida S Kent | Certified Nurse Midwife (cnm) | Park Nicollet Clinic | 6000 Earle Brown Dr, Brooklyn Center, MN 55430-2506 |
| Anne R Edwards | Pediatric Medicine | Park Nicollet Clinic | 6000 Earle Brown Dr, Brooklyn Center, MN 55430-2506 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Paul Dettling | Chiropractic | 615 66th N Ave, Suite 2, Brooklyn Center, MN 55430-1666 | |
| Kimberly J Oftedahl-brooks | Clinical Social Worker | Associated Clinic of Psychology Inc | 6200 Shingle Creek Pkwy, Suite 350, Brooklyn Center, MN 55430-2155 |
| Juneau Ronnye Hill-armstrong | Clinical Social Worker | 5701 Shingle Creek Pkwy, Suite 500t, Brooklyn Center, MN 55430-2386 | |
| Tammy M Danielson | Physician Assistant | North Memorial Health Care | 5615 Xerxes N Ave D, Brooklyn Center, MN 55430-2819 |
| Erik S Haugland | Family Medicine | North Memorial Health Care | 5615 Xerxes N Ave D, Brooklyn Center, MN 55430-2819 |
| Edward D Augdahl | Optometry | Eda, Inc | 5515 Xerxes Ave N, Brooklyn Center, MN 55430-2856 |
| Thomas A Breitenbucher | Psychologist, Clinical | North Psychology Clinic Pa | 6120 Earle Brown Dr, Suite 520, Brooklyn Center, MN 55430-4112 |
| Rochelle J Brandl | Psychologist, Clinical | North Psychology Clinic Pa | 6120 Earle Brown Dr, Suite 520, Brooklyn Center, MN 55430-4112 |
| Dorothy S Edelson | Clinical Psychologist | North Psychology Clinic Pa | 6120 Earle Brown Dr, Brooklyn Center, MN 55430-4112 |
| Gay R Hallberg | Clinical Psychologist | North Psychology Clinic Pa | 6120 Earle Brown Dr, Suite 520, Brooklyn Center, MN 55430-4112 |
| Find all physicians in zip 55430 | |||
| City | BROOKLYN CENTER |
| Zip Code | 55430 |
| Specialty | INTERNAL MEDICINE |
| City + Specialty | BROOKLYN CENTER + INTERNAL MEDICINE |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.