Jeffrey E Petersen (NPI# 1275551707, PAC ID# 8527163286) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is DERMATOLOGY.
| Nation Provider ID (NPI) | 1275551707 |
| PAC ID by PECOS | 8527163286 |
| Professional Enrollment ID | I20070425000332 |
| Full Name | Jeffrey E Petersen |
| Organization Legal Name | ST LOUIS DERMATOLOGY LLC |
| Address |
1011 Bowles Ave Suite 121 Fenton MO 63026-2387 |
| Phone Number | 3142002713 |
| Gender | M |
| Credential | MD |
| Medical School | INDIANA UNIVERSITY SCHOOL OF MEDICINE |
| Graduation Year | 1995 |
| Primary Specialty | DERMATOLOGY |
| Group Practice PAC ID | 7517197247 |
| Number of Group Practice Members | 3 |
| Accepts Medicare Assignment | Y |
| Address | Phone | Organization |
|---|---|---|
| 1011 Bowles Ave, Suite 121, Fenton, MO 63026-2387 | 3142002713 | ST LOUIS DERMATOLOGY LLC |
| Measure Identifier | Measure Title | Performance Rate | Reporting Mechanism |
|---|---|---|---|
| ACI_EC_TRANS_PPHI_1 | Security Risk Analysis | % | |
| MIPS_EC_137_overall | Melanoma: Continuity of Care - Recall System | 100% | |
| MIPS_EC_138_overall | Melanoma: Coordination of Care | 100% | |
| MIPS_EC_224_overall | Melanoma: Overutilization of Imaging Studies in Melanoma | 100% | |
| MIPS_EC_265_overall | Biopsy Follow-Up | 100% | |
| MIPS_EC_402_overall | Tobacco Use and Help with Quitting Among Adolescents | 100% |
| Organization Legal Name | ST LOUIS DERMATOLOGY LLC |
| Physicians | 3 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Anastasia A Averbukh | Nurse Practitioner | St Louis Dermatology LLC | 1011 Bowles Ave, Suite 121, Fenton, MO 63026-2387 |
| Elizabeth Anne Rancour | Dermatology | St Louis Dermatology LLC | 1011 Bowles Ave, Suite 121, Fenton, MO 63026-2387 |
| Street Address |
1011 BOWLES AVE SUITE 121 |
| City | FENTON |
| State | MO |
| Zip | 63026-2387 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Susan J Davis | Family Medicine | Ssm Medical Group Inc | 1011 Bowles Ave, Suite 300, Fenton, MO 63026-2387 |
| Lawrence V Boveri | Obstetrics/gynecology | County Obstetrics and Gynecology, Inc | 1011 Bowles Ave, Suite 215, Fenton, MO 63026-2387 |
| Eddy Chung-chiang Hsueh | General Surgery | St Louis University | 1011 Bowles Ave, Suite 425, Fenton, MO 63026-2384 |
| Sean B Bailey | Otolaryngology | Sound Health Services PC | 1011 Bowles Ave, Suite 405, Fenton, MO 63026-2387 |
| Richard B Whiting | Internal Medicine | Ssm Medical Group Inc | 1011 Bowles Ave, Fenton, MO 63026-2387 |
| Sarah J Ludlow | Family Medicine | Ssm Medical Group Inc | 1011 Bowles Ave, Suite 300, Fenton, MO 63026-2387 |
| Stephanie Becker Koepke | Hematology/oncology | Ssm Medical Group Inc | 1011 Bowles Ave, Suite G50, Fenton, MO 63026-0562 |
| Anastasia A Averbukh | Nurse Practitioner | St Louis Dermatology LLC | 1011 Bowles Ave, Suite 121, Fenton, MO 63026-2387 |
| Naomi Sharon | Nurse Practitioner | Ssm Medical Group Inc | 1011 Bowles Ave, Suite G50, Fenton, MO 63026-0562 |
| Elizabeth Anne Rancour | Dermatology | St Louis Dermatology LLC | 1011 Bowles Ave, Suite 121, Fenton, MO 63026-2387 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| David E Morris | Radiation Oncology | Ssm Medical Group Inc | 1011 Bowles Ave, Suite G50, Fenton, MO 63026-0562 |
| Carol Yacula | Nurse Practitioner | Ssm Medical Group Inc | 1011 Bowles Ave, Suite G50, Fenton, MO 63026-0562 |
| Janelle Roethemeyer | Internal Medicine | American Multispecialty Group Inc | 1011 Bowles Ave, Suite 450, Fenton, MO 63026-0562 |
| Sri D Kolli | Internal Medicine | American Multispecialty Group Inc | 1011 Bowles Ave, Suite 450, Fenton, MO 63026-0562 |
| Katherine C Schoo | Nurse Practitioner | Mercy Clinic East Communities | 1375 N Hwy Dr, Mercy Clinic At Work Maritz, Fenton, MO 63026-1929 |
| Matthew J Tiefenbrunn | Family Medicine | Mercy Clinic East Communities | 1375 N Hwy Dr, Mercy Clinic At Work Maritz, Fenton, MO 63026-1929 |
| Evelyn Barton | Physical Therapy | 1700 B Gilsinn Ln, Fenton, MO 63026-2004 | |
| Adeluola G Lipede | Thoracic Surgery | 960s Hwy Dr, Fenton, MO 63026-2023 | |
| Hari T Srihari | Cardiovascular Disease (cardiology) | Ssm Medical Group Inc | 1055 Bowles Ave, Suite 200, Fenton, MO 63026-2308 |
| Chad C Shelton | Interventional Pain Management | Pro Pain LLC | 1055 Bowles Ave, Suite 202, Fenton, MO 63026-2308 |
| Find all physicians in zip 63026 | |||
| City | FENTON |
| Zip Code | 63026 |
| Specialty | DERMATOLOGY |
| City + Specialty | FENTON + DERMATOLOGY |
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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.