GREGORY PETERSEN PHD
NPI 1275509804
Psychologist - Clinical in Roanoke, VA
About Gregory Petersen Phd NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
GREGORY PETERSEN PHD (NPI 1275509804) is an individual clinical provider in Roanoke, Virginia, licensed in Virginia (0810-002774) and active in the NPI registry since February 2006. He is enrolled in Medicare PECOS and is a graduate of Other (1999).
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Gregory Petersen Phd 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.
Medicare Billing Reassignment
Medicare enrollment records show Gregory Petersen reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Carol Stream, IL 60122
- Reassigned Medicare billing, Illinois enrollment
- 4,817 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.
Areas of Expertise CMS Part B claims 2
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 24014 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
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.
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.
ROANOKE, VA 24014
ROANOKE, VA 24014
ROANOKE, VA 24014
ROANOKE, VA 24014
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 Gregory Petersen's NPI number?
The NPI number for Gregory Petersen is 1275509804. It was assigned to this individual provider in the NPPES registry on February 24, 2006.
Where is Gregory Petersen located?
Gregory Petersen practices at 2017 Jefferson St SW, Roanoke, VA 24014. The listed phone number is (540) 981-7097.
What is Gregory Petersen's specialty?
The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.
Is Gregory Petersen enrolled in Medicare?
Yes. Gregory Petersen is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organization bills Medicare for Gregory Petersen's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Gregory Petersen reassigns Medicare benefits to Northwestern Medical Faculty Foundation (Carol Stream, IL). 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 Gregory 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 Gregory Petersen was last updated on July 13, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 months 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.
# Gregory Petersen, PHD · NPI 1275509804
Clinical provider in Roanoke, Virginia. Individual provider, active in the CMS NPPES registry since February 24, 2006.
## Identity
- **NPI:** 1275509804 (Entity type: Individual)
- **Enumerated:** February 24, 2006
- **Primary specialty:** Psychologist - Clinical · taxonomy 103TC0700X
- **State license:** 0810-002774 (Virginia)
- **Sole proprietor:** No
## Practice location
- **Address:** 2017 JEFFERSON ST SW, Roanoke, VA 24014-2419
- **Phone:** (540) 981-7097
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** Northwestern Medical Faculty Foundation (NPI 1346235314, Carol Stream, IL), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 1999
## Record status
- **NPPES last updated:** July 13, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1275509804) · Data from the CMS NPPES public registry.