DR. DUSTIN J PETERSEN (M.D.) – Surgical Critical Care Physician, NPI 1265661383

DR. DUSTIN J PETERSEN (M.D.) is a healthcare provider. based in Fort wayne, Indiana. specializing in HOSPICE/PALLIATIVE CARE, GENERAL PRACTICE. They hold the professional credentials M.D.. They hold a License No. 26510 (WV). The NPI Number for DR. DUSTIN J PETERSEN (M.D.) is 1265661383

Main info

Male
19 Years Of Experience
Accepts Medicare Assignment
Name
DR. DUSTIN J PETERSEN (M.D.)
NPI
1265661383
Phone
(260) 266-8900
Address
11141 PARKVIEW PLAZA DR STE 305
Enumeration Date
10 July 2009
Last Update Date
10 October 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2604353222
Graduation Year
2007 (19 years ago)
PAC ID
0547408619
Group Practice PAC ID
4082703608
Professional Enrollment ID
I20170302002444
Address ID
IN468251619FO2514XRDXX402

Contacts

Secure Messaging
dpetersen106946@Direct.Parkviewexchange.com
FHIR Endpoint
https://epicprod-mobile.parkview.com/FHIR/api/FHIR/DSTU2/
FHIR Endpoint
https://epicprod-mobile.parkview.com/FHIR/api/FHIR/R4/
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience75
Completeness85
Years active:16State licenses:2Other namesUpdated within 12 months

101 HOSPICE/PALLIATIVE CARE in IN

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Provider Addresses for DR. DUSTIN J PETERSEN (M.D.)

  • Parkview Plaza Drive, Fort Wayne, Allen County, Indiana, 46845, United States

    FORT WAYNE, IN 468451715

    Phone: (260) 266-8900

    Fax: (260) 266-8935

    Type: Location

  • 3926, New Vision Drive, Fort Wayne, Allen County, Indiana, 46845, United States

    FORT WAYNE, IN 468451712

    Phone: (260) 266-1401

    Fax: (260) 458-5734

    Type: Mailing

  • 11109 PARKVIEW PLAZA DR # 117

    FORT WAYNE, IN 468451701

    Phone:

    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: 2017-03-02

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

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

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20170302002444IGeneral PracticeINTBD

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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99222Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes2320$0
View full utilization report →

Insurance plans in this area (ZIP 46845)

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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: 4082703608View full group profile
NameSpecialtyState
-IN
-FL
Geriatric Medicine, Hospice/Palliative Care, Internal MedicineIN
Nurse PractitionerIN
Nurse PractitionerIN
-IN

Reviews

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Frequently asked questions

How do I look up DR. DUSTIN J PETERSEN (M.D.) by NPI?
Use NPI 1265661383 when you need to reference DR. DUSTIN J PETERSEN (M.D.) in forms, claims, or directories.
Is DR. DUSTIN J PETERSEN (M.D.) currently active in the NPI registry?
CMS-published data lists DR. DUSTIN J PETERSEN (M.D.) as an active registrant.
What field does DR. DUSTIN J PETERSEN (M.D.) work in?
You can think of DR. DUSTIN J PETERSEN (M.D.) as practicing within Surgical Critical Care Physician. Clinical services aligned with this taxonomy classification.
Does DR. DUSTIN J PETERSEN (M.D.) practice in Indiana?
You will see Fort Wayne, Indiana on file for DR. DUSTIN J PETERSEN (M.D.) alongside any extra practice locations.
Is DR. DUSTIN J PETERSEN (M.D.) a real provider?
This page reflects official NPPES data for NPI 1265661383. Always confirm identity and privileges with the practice and licensing boards.

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