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KRISTIN LB PETERSON MD
NPI 1124029756
Pediatrics in St. Paul, MN

Active since August 04, 2005PECOS Enrolled
CHILDREN'S PRIMARY CLINIC - STPL, 347 NORTH SMITH AVENUE, ST. PAUL, MN 55102(651) 220-6789(651) 220-6807 Get Directions Write a Review

NPPES record last updated: September 4, 2012. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Kristin Lb Peterson Md NPPES

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

KRISTIN LB PETERSON MD (NPI 1124029756) is an individual pediatrics provider in St. Paul, Minnesota, licensed in Minnesota (42034) and active in the NPI registry since August 2005. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1124029756
Entity TypeIndividualFemale
Primary Taxonomy208000000X
Provider Legal NameKRISTIN LB PETERSONCredential: MD
Location AddressCHILDREN'S PRIMARY CLINIC - STPL, 347 NORTH SMITH AVENUESt. Paul, MN 55102
Mailing AddressChildren's Health Care, 2910 Centre Pointe Drive 35-121aRoseville, MN 55113 · (651) 855-2327 · Fax (651) 855-2310
Phone(651) 220-6789
Fax(651) 220-6807
Sole ProprietorNo
Enumeration DateAugust 4, 2005
Last NPPES UpdateSeptember 4, 2012
✔ NPI 1124029756 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
License✔ Licensed in MN · 42034
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
CHILDREN'S PRIMARY CLINIC - STPL, St. Paul, MN 55102
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Other Identifiers 3

Medicare ID-Type Unspecified370002978
Medicaid400042100MN
Medicare UPINH16399

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kristin Lb 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.

Medicare Billing Reassignment

Medicare enrollment records show Kristin Peterson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Childrens Health Care
0.8 mi
Multi-Specialty
345 NORTH SMITH AVENUE, CHILDRENS SPECIALTY CLINICS STPL
St Paul, MN 55102
  • Reassigned Medicare billing, Minnesota enrollment
  • Medicare enrollment name: Children's Health Care
  • 551 clinicians in this Medicare group
NPI 1225132566 (651) 220-6000

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 55102 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
$85.82 typical visit price
range $56.00 – $168.28
Typical copayment $21.45 (range $14.00 – $42.07)
Most-billed visit code 99203
Established Patient
$98.61 typical visit price
range $18.32 – $138.04
Typical copayment $24.65 (range $4.58 – $34.51)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 2

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

MARY M ERICKSON RNC PNP MPH
Nurse Practitioner (Pediatrics)
CHILDREN'S PRIMARY CLINIC - STPL, 347 NORTH SMITH AVENUE
ST PAUL, MN 55102
Ramsey County (651) 220-6789
VIRGINIA M MCCARTHY CPNP
Nurse Practitioner (Pediatrics)
CHILDREN'S PRIMARY CLINIC - STPL, 347 NORTH SMITH AVENUE
ST PAUL, MN 55102
Ramsey County (651) 220-6789

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 Kristin Peterson's NPI number?

The NPI number for Kristin Peterson is 1124029756. It was assigned to this individual provider in the NPPES registry on August 4, 2005.

Where is Kristin Peterson located?

Kristin Peterson practices at Children's Primary Clinic - Stpl 347 North Smith Avenue, St. Paul, MN 55102. The listed phone number is (651) 220-6789.

What is Kristin Peterson's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Is Kristin Peterson enrolled in Medicare?

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

Which organization bills Medicare for Kristin Peterson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kristin Peterson reassigns Medicare benefits to Childrens Health Care (St Paul, MN). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kristin Peterson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Kristin Peterson was last updated on September 4, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.