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GLENRIDGE FAMILY MEDICINE
NPI 1659563989
Family Medicine in Glenville, NY

Active since August 10, 2007
15 GLENRIDGE RD, GLENVILLE, NY 12302(518) 399-0909(518) 399-2640 Get Directions Write a Review

NPPES record last updated: August 10, 2007. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Glenridge Family Medicine NPPES

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

GLENRIDGE FAMILY MEDICINE (NPI 1659563989) is a healthcare organization registered as a family medicine in Glenville, New York and active in the NPI registry since August 2007. The organization lists Lauris Jon Petersen, Ceo/president, as its authorized official.

NPPES Registry Identity

NPI1659563989
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameLAURIS J. PETERSEN MD PC
Location Address15 GLENRIDGE RDGlenville, NY 12302-4520
Mailing Address15 Glenridge RdGlenville, NY 12302-4520 · (518) 399-0909 · Fax (518) 399-2640
Phone(518) 399-0909
Fax(518) 399-2640
Organization SubpartNo
Authorized OfficialLauris Jon PetersenCeo/president · (518) 399-0909
Enumeration DateAugust 10, 2007
✔ NPI 1659563989 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in NY · 213320
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
15 GLENRIDGE RD, Glenville, NY 12302
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Other Names 1

Doing Business AsGlenridge Family Medicine

Other Identifiers 1

Medicare PINBA0100NY

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Glenridge Family Medicine is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Glenridge Family Medicine, which bills Medicare for the services this clinician delivers.

Clinician (1)

Lauris Petersen, MD
Family Practice
NPI 1629152301
15 GLENRIDGE RD
Glenville, NY 12302
(518) 399-0909
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Lauris J. Petersen MD PC's NPI number?

The NPI number for Lauris J. Petersen MD PC is 1659563989. It was assigned to this organization in the NPPES registry on August 10, 2007. The provider is doing business as Glenridge Family Medicine.

Where is Lauris J. Petersen MD PC located?

Lauris J. Petersen MD PC is located at 15 Glenridge Rd, Glenville, NY 12302. The listed phone number is (518) 399-0909.

What is Lauris J. Petersen MD PC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Lauris J. Petersen MD PC enrolled in Medicare?

Yes. Lauris J. Petersen MD PC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Lauris J. Petersen MD PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Family Practice) reassigns their Medicare billing to Lauris J. Petersen MD PC. A 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 the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Lauris J. Petersen MD PC was last updated on August 10, 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.