GLEN W. PETERSEN M.D.
NPI 1467495986
Internal Medicine - Pulmonary Disease in Oakland, CA

Q: What is Glen Petersen's NPI number?

The NPI number for Glen Petersen is 1467495986. It was assigned to this individual provider in the NPPES registry on June 13, 2006.

Q: What is Glen Petersen's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Pulmonary Disease, with taxonomy code 207RP1001X.

Q: When was this NPI record last updated?

The NPPES record for Glen Petersen was last updated on January 14, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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 June 13, 2006PECOS Enrolled

411 30TH ST, SUITE 314, OAKLAND, CA 94609(510) 465-6800(510) 268-0634 Get Directions Write a Review

NPPES record last updated: January 14, 2016. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Glen W. Petersen M.d. NPPES

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

GLEN W. PETERSEN M.D. (NPI 1467495986) is an individual pulmonary disease provider in Oakland, California, licensed in California (A26004) and active in the NPI registry since June 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1467495986

Entity TypeIndividualMale

Primary Taxonomy207RP1001X

Provider Legal NameGLEN W. PETERSENCredential: M.D.

Location Address411 30TH ST, SUITE 314Oakland, CA 94609-3312

Mailing Address411 30th St, Suite 314Oakland, CA 94609-3312 · (510) 841-0689 · Fax (510) 841-8119

Phone(510) 465-6800

Fax(510) 268-0634

Sole ProprietorNo

Enumeration DateJune 13, 2006

Last NPPES UpdateJanuary 14, 2016

✔ NPI 1467495986 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal Medicine · Pulmonary DiseaseAllopathic & Osteopathic Physicians

Taxonomy Code207RP1001X

License✔ Licensed in CA · A26004

Definition

An internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational and environmental diseases, bronchitis, sleep disorders, emphysema and other complex disorders of the lungs.

Also ListedInternal Medicine · Critical Care MedicineTaxonomy 207RC0200X · License A26004 (CA)

411 30TH ST, Oakland, CA 94609

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Other Identifiers 3

Medicaid00A260040CA

Medicare ID-Type Unspecified00A260041

Medicare UPINA24668

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Glen W. Petersen M.d. 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 94609 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

$153.83 typical visit price

range $69.00 – $202.35

Typical copayment $38.45 (range $17.25 – $50.58)

Most-billed visit code 99204

Established Patient

$119.48 typical visit price

range $23.44 – $166.46

Typical copayment $29.87 (range $5.86 – $41.61)

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.

Referred Medical Equipment & Supplies CMS DME claims 5

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing E0431

DME-Oxygen and Supplies · category DC000N

1 supplier12 claims12 services$14.99 avg. paid by Medicare

Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) E0465

DME-Other DME · category DE005N

1 supplier12 claims17 services$781.02 avg. paid by Medicare

Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) E0466

DME-Other DME · category DE005N

1 supplier19 claims24 services$776.41 avg. paid by Medicare

Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate E1390

DME-Oxygen and Supplies · category DC002N

2 suppliers39 claims39 services$72.06 avg. paid by Medicare

Portable oxygen concentrator, rental E1392

DME-Oxygen and Supplies · category DC002N

1 supplier26 claims27 services$32.96 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

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.

MICHELE MABRY WILSON

Counselor

411 30TH ST, #314
OAKLAND, CA 94609

Alameda County (510) 273-4200

DR. KATHRYN A KLIMA MD

Radiology (Diagnostic Radiology)

411 30TH ST, #508
OAKLAND, CA 94609

Alameda County (925) 274-4950

MOHAMED BERETEH

Counselor

411 30TH ST, SUITE 314
OAKLAND, CA 94609

Alameda County (510) 273-8340

DR. CHARLES E. FISKE M.D.

Radiology (Radiation Oncology)

411 30TH ST, #508
OAKLAND, CA 94609

Alameda County (925) 274-4950

AFFILIATES IN IMAGING, A MEDICAL GROUP INC

Radiology (Diagnostic Radiology)

411 30TH ST, #508
OAKLAND, CA 94609

Alameda County (925) 274-4950

DR. PATRICK J PERKINS MD

Radiology (Diagnostic Radiology)

411 30TH ST, #508
OAKLAND, CA 94609

Alameda County (925) 274-4950

DYNAMEDIC DRUGS INC

Durable Medical Equipment & Medical Supplies

411 30TH ST
OAKLAND, CA 94609

Alameda County (510) 834-3100

KRISTINA M. KURY M.D.

Internal Medicine (Pulmonary Disease)

411 30TH ST, SUITE 314
OAKLAND, CA 94609

Alameda County (510) 465-6800

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 Glen Petersen's NPI number?

The NPI number for Glen Petersen is 1467495986. It was assigned to this individual provider in the NPPES registry on June 13, 2006.

Where is Glen Petersen located?

Glen Petersen practices at 411 30th St Suite 314, Oakland, CA 94609. The listed phone number is (510) 465-6800.

What is Glen Petersen's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Pulmonary Disease, with taxonomy code 207RP1001X.

Is Glen Petersen enrolled in Medicare?

Yes. Glen Petersen is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Glen Petersen was last updated on January 14, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.