ANTONIO PETERSON – Speech-Language Pathologist, NPI 1740773217

ANTONIO PETERSON is a healthcare provider. based in Sebring, Florida. specializing in QUALIFIED SPEECH LANGUAGE PATHOLOGIST. They hold a License No. 16151 (FL). The NPI Number for ANTONIO PETERSON is 1740773217

Main info

Male
5 Years Of Experience
Accepts Medicare Assignment
Name
ANTONIO PETERSON
NPI
1740773217
Phone
(817) 727-7069
Address
109 N EGRET ST
Enumeration Date
11 June 2018
Last Update Date
30 April 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8188942273
Graduation Year
2021 (5 years ago)
PAC ID
4284144668
Group Practice PAC ID
5395163174
Professional Enrollment ID
I20250618003728
Address ID
CA919105561CH333XXSTXX301
Telehealth
Yes
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience49
Completeness75
Years active:8State licenses:2Digital endpointsOther names

570 QUALIFIED SPEECH LANGUAGE PATHOLOGIST in FL

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Provider Addresses for ANTONIO PETERSON

  • 109, North Egret Street, Sebring, Highlands County, Florida, 33870, United States

    SEBRING, FL 338708516

    Phone: (817) 727-7069

    Type: Mailing

  • 125, Tomoka Boulevard South, Lake Placid, Highlands County, Florida, 33852, United States

    LAKE PLACID, FL 338528123

    Phone: (863) 465-7200

    Type: Location

  • 830 AGUA MINERAL PL

    EL PASO, TX 799289056

    Phone: (817) 727-7069

    Type: Mailing

  • 815 POLLARD RD

    LOS GATOS, CA 950321438

    Phone: (863) 465-7200

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2025-06-18

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking 2 Medicare enrollment records; no due dates published yet.

Enrollment records

2

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20250605004224IQualified Speech Language PathologistTXTBD
I20250618003728IQualified Speech Language PathologistCATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 33870)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 5395163174View full group profile
NameSpecialtyState
Occupational Therapist In Private PracticeCA
Qualified Speech Language PathologistOK
Qualified Speech Language PathologistFL
Occupational Therapist In Private PracticeTX
Qualified Speech Language PathologistAZ
Qualified Speech Language PathologistMS
Qualified Speech Language PathologistCA
Qualified Speech Language PathologistTX
Qualified Speech Language PathologistTX
Occupational Therapist In Private PracticeMD

Reviews

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Frequently asked questions

Does ANTONIO PETERSON share an NPI with anyone else?
NPI numbers are unique to each provider or organization — ANTONIO PETERSON uses 1740773217.
Can I rely on ANTONIO PETERSON being an active provider?
As of the registry snapshot, ANTONIO PETERSON is marked active.
What healthcare role does ANTONIO PETERSON hold?
Scheduling teams often label ANTONIO PETERSON under Speech-Language Pathologist. Clinical services aligned with this taxonomy classification.
What area does ANTONIO PETERSON serve?
ANTONIO PETERSON's listing highlights Sebring, Florida; more addresses can appear in NPPES.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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