AMANDA D PETERSEN PA-C
NPI 1528391372
Physician Assistant - Medical in Kennewick, WA

Q: What is Amanda Petersen's NPI number?

The NPI number for Amanda Petersen is 1528391372. It was assigned to this individual provider in the NPPES registry on September 11, 2009.

Q: What is Amanda Petersen's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Q: When was this NPI record last updated?

The NPPES record for Amanda Petersen was last updated on January 22, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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 September 11, 2009PECOS Enrolled

83.05/100

CMS Quality Rating

4804 W CLEARWATER AVE, KADLEC CLINIC URGENT CARE, KENNEWICK, WA 99336(509) 942-2355(509) 222-2355 Get Directions Write a Review

NPPES record last updated: January 22, 2014. Verified against the NPPES registry weekly; last sync: September 06, 2026.

On this page

About Amanda D Petersen Pa-c NPPES

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

AMANDA D PETERSEN PA-C (NPI 1528391372) is an individual medical provider in Kennewick, Washington, licensed in Washington (PA60113833) and active in the NPI registry since September 2009. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1528391372

Entity TypeIndividualFemale

Primary Taxonomy363AM0700X

Provider Legal NameAMANDA D PETERSENCredential: PA-C

Location Address4804 W CLEARWATER AVE, KADLEC CLINIC URGENT CAREKennewick, WA 99336

Mailing Address3900 S Zintel WayKennewick, WA 99337 · (509) 942-3627 · Fax (509) 942-2268

Phone(509) 942-2355

Fax(509) 222-2355

Sole ProprietorNo

Enumeration DateSeptember 11, 2009

Last NPPES UpdateJanuary 22, 2014

✔ NPI 1528391372 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363AM0700X

Licenses✔ Licensed in WA · PA60113833✔ Licensed in WA · PENDING

4804 W CLEARWATER AVE, Kennewick, WA 99336

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Other Identifiers 1

Medicaid1528391372WA

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include PacificSource Health Plans.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Amanda D Petersen Pa-c 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 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.

83.05/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Scored as part of a group practice

Quality

76.47

Promoting Interoperability

100

Improvement Activities

Cost

67.03

Other Providers at the Same Location NPPES 10

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

PAUL A SHOEMAKER ARNP

Nurse Practitioner (Family)