DR. DAVID PETERSEN M.D.
NPI 1215900824
Pediatrics in Las Vegas, NV
About Dr. David Petersen M.d. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. DAVID PETERSEN M.D. (NPI 1215900824) is an individual pediatrics provider in Las Vegas, Nevada, licensed in Nevada (12010) and active in the NPI registry since February 2006. He is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Dr. David Petersen M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignments
2Medicare enrollment records show David Petersen reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Las Vegas, NV 89144
- Reassigned Medicare billing, Nevada enrollment
- 150 clinicians in this Medicare group
Stockton, CA 95210
- Reassigned Medicare billing, California enrollment
- 20,078 clinicians in this Medicare group
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 89109 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
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.
LAS VEGAS, NV 89109
LAS VEGAS, NV 89109
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 David Petersen's NPI number?
The NPI number for David Petersen is 1215900824. It was assigned to this individual provider in the NPPES registry on February 13, 2006.
Where is David Petersen located?
David Petersen practices at 3006 S Maryland Pkwy Ste 505, Las Vegas, NV 89109. The listed phone number is (888) 350-2911.
What is David Petersen's specialty?
The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.
Is David Petersen enrolled in Medicare?
Yes. David Petersen is registered in the Medicare PECOS enrollment system.
Which organizations bill Medicare for David Petersen's services?
According to the CMS Revalidation Reassignment List (October 2026 release), David Petersen reassigns Medicare benefits to 2 organizations: Pokroy Medical Group Of Nevada, Ltd. (Las Vegas, NV) and Permanente Medical Group Inc (Stockton, CA). Each 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 David Petersen'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 David Petersen was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 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.
# Dr. David Petersen, M.D. · NPI 1215900824
Pediatrics physician in Las Vegas, Nevada. Individual provider, active in the CMS NPPES registry since February 13, 2006.
## Identity
- **NPI:** 1215900824 (Entity type: Individual)
- **Enumerated:** February 13, 2006
- **Primary specialty:** Pediatrics · taxonomy 208000000X
- **State license:** 12010 (Nevada)
- **Sole proprietor:** No
## Practice location
- **Address:** 3006 S MARYLAND PKWY, STE 505, Las Vegas, NV 89109-2218
- **Phone:** (888) 350-2911
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Pokroy Medical Group Of Nevada, Ltd. (NPI 1992809412, Las Vegas, NV); Permanente Medical Group Inc (NPI 1548343510, Stockton, CA) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** July 8, 2007
- **Other identifiers:** Medicare UPIN RES000 (CA)
---
Source: [NPI Profile](https://npiprofile.com/npi/1215900824) · Data from the CMS NPPES public registry.