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SAMUEL R PETERSON MD
NPI 1073571295
Dermatology in Newport Beach, CA

Active since May 04, 2006PECOS Enrolled
75/100
CMS Quality Rating
360 SAN MIGUEL DR STE 309, NEWPORT BEACH, CA 92660(949) 640-0434 Get Directions Write a Review

NPPES record last updated: January 19, 2023. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jan 19, 2023, Jun 17, 2021 (2 updates tracked since 2021).

About Samuel R Peterson Md NPPES

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

SAMUEL R PETERSON MD (NPI 1073571295) is an individual dermatology provider in Newport Beach, California, licensed in California (C148028) and active in the NPI registry since May 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1073571295
Entity TypeIndividualMale
Primary Taxonomy207N00000X
Provider Legal NameSAMUEL R PETERSONCredential: MD
Location Address360 SAN MIGUEL DR STE 309Newport Beach, CA 92660-7829
Mailing Address600 Corporate Dr, Ste 100Ladera Ranch, CA 92694-2107 · (949) 388-8022 · Fax (949) 388-8033
Phone(949) 640-0434
Sole ProprietorNo
Enumeration DateMay 4, 2006
Last NPPES UpdateJanuary 19, 20232 updates tracked since enumeration
NPPES CertifiedJanuary 19, 2023
✔ NPI 1073571295 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
Licenses✔ Licensed in CA · C148028✔ Licensed in UT · 52631431205
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
360 SAN MIGUEL DR STE 309, Newport Beach, CA 92660
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Other Identifiers 7

Other107017630101UT · Ihc Healthplans
OtherQM0000066345UT · Altius
OtherP00066498UT · Palmetto Gba
Other03.00174UT · United Healthcare
Other72756UT · Pehp
Other796725UT · Dmba
Medicaid870281028000UT

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Samuel R Peterson Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 92660 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$96.36 typical visit price
range $62.96 – $187.60
Typical copayment $24.09 (range $15.74 – $46.90)
Most-billed visit code 99203
Established Patient
$77.96 typical visit price
range $20.84 – $153.61
Typical copayment $19.49 (range $5.21 – $38.40)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

75/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice

Other Providers at the Same Location NPPES 4

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

DR. EDWARD GEORGE ROHALY M.D,.
Dermatology
360 SAN MIGUEL DR STE 309
NEWPORT BEACH, CA 92660
Orange County (949) 640-0434
MIRIAM ESHOIEE
Physician Assistant
360 SAN MIGUEL DR STE 309
NEWPORT BEACH, CA 92660
Orange County (949) 640-0434
MARILYNNE M BROWNELL
Nurse Practitioner
360 SAN MIGUEL DR STE 309
NEWPORT BEACH, CA 92660
Orange County (949) 640-0434
DR. BLAIR ROSE MD
Dermatology
360 SAN MIGUEL DR STE 309
NEWPORT BEACH, CA 92660
Orange County (949) 640-0434

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Samuel Peterson's NPI number?

The NPI number for Samuel Peterson is 1073571295. It was assigned to this individual provider in the NPPES registry on May 4, 2006.

Where is Samuel Peterson located?

Samuel Peterson practices at 360 San Miguel Dr Ste 309, Newport Beach, CA 92660. The listed phone number is (949) 640-0434.

What is Samuel Peterson's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Is Samuel Peterson enrolled in Medicare?

Yes. Samuel Peterson is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Samuel Peterson was last updated on January 19, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.