MRS. HOLLY SUZANNE PETERSON PA-C
NPI 1285278614
Physician Assistant in Rexburg, ID

Q: What is Holly Peterson's NPI number?

The NPI number for Holly Peterson is 1285278614. It was assigned to this individual provider in the NPPES registry on October 29, 2019.

Q: What is Holly Peterson's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Q: When was this NPI record last updated?

The NPPES record for Holly Peterson was last updated on August 26, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.

Active since October 29, 2019PECOS EnrolledAccepts Medicare Assignment

72 S 1ST E STE 101, REXBURG, ID 83440(208) 356-4900(208) 356-3724 Get Directions Write a Review

NPPES record last updated: August 26, 2024. Verified against the NPPES registry weekly; last sync: August 30, 2026.

On this page

About Mrs. Holly Suzanne Peterson Pa-c NPPES

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

MRS. HOLLY SUZANNE PETERSON PA-C (NPI 1285278614) is an individual physician assistant in Rexburg, Idaho, licensed in Idaho (PA-1814) and active in the NPI registry since October 2019. She is enrolled in Medicare PECOS, is affiliated with Madison Memorial Hospital, and maintains a secondary practice location in Saint Anthony.

NPPES Registry Identity

NPI1285278614

Entity TypeIndividualFemale

Primary Taxonomy363A00000X

Provider Legal NameMRS. HOLLY SUZANNE PETERSONCredential: PA-C

Location Address72 S 1ST E STE 101Rexburg, ID 83440-1965

Mailing AddressPo Box 18Saint Anthony, ID 83445-0018 · (208) 356-4900 · Fax (208) 624-4112

Phone(208) 356-4900

Fax(208) 356-3724

Sole ProprietorNo

Medical School CMSOtherGraduated 2019

Enumeration DateOctober 29, 2019

Last NPPES UpdateAugust 26, 2024

NPPES CertifiedAugust 26, 2024

✔ NPI 1285278614 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

License✔ Licensed in ID · PA-1814

Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

72 S 1ST E STE 101, Rexburg, ID 83440

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Secondary Practice Location 1

Location 1335 E Main St Ste 101Saint Anthony, ID 83445-1546 · Phone (208) 356-4900 · Fax (208) 624-4116

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Moda Health Plan, Inc., Providence Health Plan, Select Health and more.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

Mrs. Holly Suzanne Peterson Pa-c 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 ID5193152189

PECOS Enrollment IDI20200304001734

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 2

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

Madison Memorial Hospital

Acute Care Hospitals · Rexburg, ID

5/5 CMS rating

OwnershipGovernment - Local

CMS Certification Number130025

Location450 East Main StreetRexburg, ID 83440 · Madison County

Emergency services

Idaho Falls Community Hospital, LLC

Acute Care Hospitals · Idaho Falls, ID

3/5 CMS rating

OwnershipProprietary

CMS Certification Number130074

Location2327 Coronado StIdaho Falls, ID 83404 · Bonneville County

Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 83440 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

$81.13 typical visit price

range $52.44 – $160.17

Typical copayment $20.28 (range $13.11 – $40.04)

Most-billed visit code 99203

Established Patient

$65.77 typical visit price

range $16.68 – $130.93

Typical copayment $16.44 (range $4.17 – $32.73)

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.

Other Providers at the Same Location NPPES 7

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

DAVE ROBINSON PA-C

Physician Assistant