KENNETH R. PETERSEN (MD) – Internal Medicine Physician, NPI 1912017104
Internal Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
8,824 INTERNAL MEDICINE in IL
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Provider Addresses for KENNETH R. PETERSEN (MD)
7702, North Alpine Road, Loves Park, Winnebago County, Illinois, 61111, United States
LOVES PARK, IL 611113107
Phone: (815) 971-2000
Fax: (815) 971-9266
Type: Mailing
7701 W ASPERA BLVD
GLENDALE, AZ 853087947
Phone: (623) 465-6060
Fax: (623) 242-5833
Type: Location
7701 W ASPERA BLVD STE 201
GLENDALE, AZ 853087947
Phone: (623) 465-6060
Fax: (623) 242-5833
Type: Mailing
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: 2021-11-29
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20211129002333 | I | Internal Medicine | AZ | TBD |
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.
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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 234 | 140 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 109 | 87 | $0 |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 34 | 34 | $0 |
| 99203 | New patient office or other outpatient visit, 30-44 minutes | 28 | 28 | $0 |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 27 | 27 | $0 |
Insurance plans in this area (ZIP 61111)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| INTERNAL MEDICINE | IL | 90670 | Pneumococcal vaccine for injection into muscle | 85 | 85 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Internal Medicine, Gastroenterology | TN | |
| - | AZ | |
| General Surgery, Vascular Surgery | AZ | |
| Orthopedic Surgery, Hand Surgery | AZ | |
| Physician Assistant | WA | |
| Physician Assistant | AZ | |
| Internal Medicine | AZ | |
| Internal Medicine | AZ | |
| - | AZ | |
| Nurse Practitioner | WA |
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