DR. LAURIS J PETERSEN (NPI# 1629152301) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629152301 |
| Entity Type | Individual |
| Full Name | DR. LAURIS J PETERSEN |
| Credential | MD |
| Practice Address |
15 Glenridge Rd Glenville NY 12302-4520 |
| Mailing Address |
5 Monarda Dr Scotia NY 12302-4202 |
| Practice Telephone | 5183990909 |
| Practice Fax Number | 5183992640 |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 213320 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | MVP | 714547 | 01 |
| NY | EMPIRE BLUE | 76V271 | 01 |
| NY | BLUE SHIELD OF NENY | 000491234003 | 01 |
| NY | CDPHP | 10031080 | 01 |
| NY | RAILROAD MEDICARE | P00315575 | 01 |
| Street Address |
15 GLENRIDGE RD |
| City | GLENVILLE |
| State | NY |
| Zip Code | 12302-4520 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659563989 | Lauris J. Petersen Md PC | Family Medicine | 15 Glenridge Rd, Glenville, NY 12302-4520 | 2007-08-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053921973 | Maria Magnoua Castaneda | Case Manager/Care Coordinator | 701 Carnbridge Manor Dr., Scotia, NY 12302 | 2020-08-05 |
| 1184050353 | Empire Vision Centers, Inc | Eyewear Supplier (Equipment, not the service) | 10 Glenridge Rd Store#1, Glenville, NY 12302 | 2013-09-19 |
| 1265773212 | Caroline M Lupi | Licensed Practical Nurse | 19 Glenridge Rd Ste E, Glenville, NY 12302 | 2013-03-14 |
| 1477805844 | Kinum Chiropractic PC | Chiropractor | 201glen Ave., Scotia, NY 12302 | 2012-10-10 |
| 1558686444 | Marsha M Tulloch | Licensed Practical Nurse | 125 Mohawk Ave, Gentle Home Health Care, Scotia, NY 12302 | 2010-04-02 |
| 1841515988 | Maureen K. Hansen | Licensed Practical Nurse | 109 Mohawk Ave., Gentle Home Health Care, Inc., Scotia, NY 12302 | 2010-04-01 |
| 1275858425 | Flora Lynn Worden | Licensed Practical Nurse | 109 Mohawk Ave, Scotia, NY 12302 | 2010-03-31 |
| 1255654943 | Kevin Daniel Valade | Pharmacist | 257 Saratoga Rd., Glenville, NY 12302 | 2010-03-09 |
| 1356574149 | Ann Elizabeth Helbling | Community Health Worker | 419 Weatherwax Road, Glenville, NY 12302 | 2009-08-27 |
| 1689811317 | Roger Guy Singer | Chiropractor | 353 Saratoga Road, Scotia, NY 12302 | 2009-01-16 |
| Find all providers in zip 12302 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| 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. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578090486 | Aaron M Frymier | Family Medicine | 921 Mineral Rd # 101, Glenville, WV 26351-1342 | 2017-05-23 |
| 1487864732 | William Joseph Duke Dufresne | Family Medicine | 1087 Sacandaga Rd, Glenville, NY 12302-6065 | 2007-05-23 |
| 1982707469 | Carl Edwin Nichols | Family Medicine | Gilmer County Urgent Care, 101 College Street, Glenville, WV 26351-0299 | 2006-09-07 |
| 1902113699 | Khyber Khan | Family Medicine | 115 Saratoga Rd, Glenville, NY 12302-4211 | 2010-09-02 |
| 1659563989 | Lauris J. Petersen Md PC | Family Medicine | 15 Glenridge Rd, Glenville, NY 12302-4520 | 2007-08-10 |
| 1366479297 | Hilary Dawn Miller | Family Medicine | 604 W Main St, Glenville, WV 26351 | 2006-06-27 |
| 1295770600 | Little Kanawha Family Medicine Pllc | Family Medicine | 604 W Main St, Glenville, WV 26351 | 2006-06-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881295558 | Mamoon Malik | Family Medicine | 90 Menands Rd, Albany, NY 12204-1400 | 2020-11-08 |
| 1336749571 | Chowdhury Medical PC | Family Medicine | 155 Alkier St, Brentwood, NY 11717-5129 | 2020-10-27 |
| 1356940084 | Rebecca Jean Smouse | Family Medicine | 1107 Prendergast Ave, Jamestown, NY 14701-3315 | 2020-10-23 |
| 1336748136 | Rapha House Calls | Family Medicine | 2 Fernglade Ct, Chester, NY 10918-2637 | 2020-10-22 |
| 1174122980 | Richmond Health Partners Ipa LLC | Family Medicine | 1161 Victory Blvd, Staten Island, NY 10301-3621 | 2020-10-22 |
| 1730787128 | Michael C Secallus | Family Medicine | 66 Kirkwood Gdns, Kirkwood, NY 13795-1623 | 2020-10-16 |
| 1861099053 | Julia Gross Family Health Nurse Practitioner, Pllc | Family Medicine | 950 Route 146 Ste 100, Clifton Park, NY 12065-3667 | 2020-10-01 |
| 1013523190 | Steinway Hope Medical LLC | Family Medicine | 8829 54th Ave Fl 2, Elmhurst, NY 11373-4543 | 2020-09-23 |
| 1538774500 | Jenny Brandt | Family Medicine | 3048 Sunset Ln # 2, Schenectady, NY 12303-5528 | 2020-09-15 |
| 1992319016 | Sarah Glaser | Family Medicine | 30 W 24th St, New York, NY 10010-3207 | 2020-09-04 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.