MATTHEW PETERSEN PA
NPI 1053764639
Physician Assistant - Surgical in Houston, TX

Q: What is Matthew Petersen's NPI number?

The NPI number for Matthew Petersen is 1053764639. It was assigned to this individual provider in the NPPES registry on July 19, 2016.

Q: What is Matthew Petersen's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Surgical, with taxonomy code 363AS0400X.

Q: When was this NPI record last updated?

The NPPES record for Matthew Petersen was last updated on April 28, 2022. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since July 19, 2016PECOS EnrolledAccepts Medicare Assignment

10425 HUFFMEISTER RD STE 320, HOUSTON, TX 77065(281) 955-2650(281) 955-5875 Get Directions Write a Review

NPPES record last updated: April 28, 2022. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Apr 28, 2022, Oct 20, 2021 (2 updates tracked since 2021).

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About Matthew Petersen Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MATTHEW PETERSEN PA (NPI 1053764639) is an individual surgical provider in Houston, Texas and active in the NPI registry since July 2016. He is enrolled in Medicare PECOS, is affiliated with Hca Houston Healthcare Kingwood, and maintains a secondary practice location in Houston.

NPPES Registry Identity

NPI1053764639

Entity TypeIndividualMale

Primary Taxonomy363AS0400X

Provider Legal NameMATTHEW PETERSENCredential: PA

Location Address10425 HUFFMEISTER RD STE 320Houston, TX 77065-3429

Mailing Address11800 Fm 1960 Rd WHouston, TX 77065-3840 · (281) 664-2107 · Fax (281) 955-5875

Phone(281) 955-2650

Fax(281) 955-5875

Sole ProprietorNo

Medical School CMSOtherGraduated 2016

Enumeration DateJuly 19, 2016

Last NPPES UpdateApril 28, 20222 updates tracked since enumeration

NPPES CertifiedApril 28, 2022

✔ NPI 1053764639 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · SurgicalPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363AS0400X

10425 HUFFMEISTER RD STE 320, Houston, TX 77065

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Secondary Practice Location 1

Location 122485 Tomball Pkwy Ste 2100Houston, TX 77070-1560 · Phone (281) 955-2650 · Fax (281) 955-5875

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include UnitedHealthcare.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Matthew Petersen Pa is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2860789641

PECOS Enrollment IDI20160921002724

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Hca Houston Healthcare Kingwood

Acute Care Hospitals · Kingwood, TX

3/5 CMS rating

OwnershipProprietary

CMS Certification Number450775

Location22999 Us Hwy 59Kingwood, TX 77325 · Harris County

Emergency services Birthing friendly

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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

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