CHARLES E PETERSON (MD) – Vascular Surgery Physician, NPI 1326025495
Vascular Surgery Physician
Main info
Doctor Profile
Contacts
Profile Insights
NPPES metrics only — not quality of care.
Loading map...
Provider Addresses for CHARLES E PETERSON (MD)
Memorial Drive, South Bend, Pacific County, Washington, 98586, United States
SOUTH BEND, IN 466011064
Phone: (574) 236-1888
Fax: (574) 236-1887
Type: Location
710 N NILES AVE
SOUTH BEND, IN 466171924
Phone: (574) 647-1610
Fax: (574) 237-6069
Type: Mailing
500 Arcade Ave Ste 210
Elkhart, IN 465142485
Phone: (574) 389-5656
Type: Location
621 MEMORIAL DR STE 502
SOUTH BEND, IN 466011075
Phone: (574) 647-5875
Fax: (574) 647-5878
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
Loading prescription activity...
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: 2009-12-22
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 |
|---|---|---|---|---|
| I20091222000283 | I | General Surgery | IN | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 46601)
Loading plans...
Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| GENERAL SURGERY | IN | 93922 | Ultrasound study of arteries of both arms and legs | 18 | 17 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Cardiovascular Disease (Cardiology), Interventional Cardiology | IN | |
| Nurse Practitioner | IN | |
| - | IN | |
| Qualified Audiologist | IN | |
| Nurse Practitioner | IN | |
| - | IN | |
| Nurse Practitioner | IN | |
| - | IN | |
| General Surgery | IN | |
| - | IN |
Reviews
All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.
No reviews yet. Be the first to share your experience — your opinion helps families compare providers.