1. Home
  2. Directory
  3. Minnesota
  4. Minneapolis
  5. Student In An Organized Health Care Education Training Program
  6. NPI Profile

DR. THEODORE VINCENT PETERSON MD, PHD
NPI 1922741701
Student in an Organized Health Care Education/Training Program in Minneapolis, MN

Active since April 19, 2022PECOS Enrolled
420 DELAWARE STREET SE, MMC 292, MINNEAPOLIS, MN 55455(612) 625-6916 Get Directions Write a Review

NPPES record last updated: June 8, 2023. Verified against the NPPES registry weekly; last sync: August 23, 2026.

Record update history: Jun 8, 2023, Apr 19, 2022 (2 updates tracked since 2022).

About Dr. Theodore Vincent Peterson Md, Phd NPPES

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

DR. THEODORE VINCENT PETERSON MD, PHD (NPI 1922741701) is an individual student in an organized health care education/training program in Minneapolis, Minnesota and active in the NPI registry since April 2022. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1922741701
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameDR. THEODORE VINCENT PETERSONCredential: MD, PHD
Location Address420 DELAWARE STREET SE, MMC 292Minneapolis, MN 55455
Mailing Address420 Delaware Street Se, Mmc 292Minneapolis, MN 55455 · (612) 625-6916
Phone(612) 625-6916
Sole ProprietorNo
Enumeration DateApril 19, 2022
Last NPPES UpdateJune 8, 20232 updates tracked since enumeration
NPPES CertifiedMay 31, 2023
✔ NPI 1922741701 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
420 DELAWARE STREET SE, MMC 292, Minneapolis, MN 55455
Open in Google Maps ↗

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Theodore Vincent Peterson Md, Phd 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.

Other Providers at the Same Location NPPES 3

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

MR. KAMRAN MASOOD M.D
Student in an Organized Health Care Education/Training Program
420 DELAWARE STREET SE, MMC 292
MINNEAPOLIS, MN 55455
Hennepin County (612) 626-5566
ILEASA GREEN DO
Student in an Organized Health Care Education/Training Program
420 DELAWARE STREET SE, MMC 292
MINNEAPOLIS, MN 55455
Hennepin County (612) 626-5589
KRISTEN HANSEN WARD DO
Student in an Organized Health Care Education/Training Program
420 DELAWARE STREET SE, MMC 292
MINNEAPOLIS, MN 55455
Hennepin County (612) 626-5589

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 Theodore Peterson's NPI number?

The NPI number for Theodore Peterson is 1922741701. It was assigned to this individual provider in the NPPES registry on April 19, 2022.

Where is Theodore Peterson located?

Theodore Peterson practices at 420 Delaware Street SE, Mmc 292, Minneapolis, MN 55455. The listed phone number is (612) 625-6916.

What is Theodore Peterson's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Theodore Peterson enrolled in Medicare?

Yes. Theodore Peterson is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Theodore Peterson was last updated on June 8, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.