TAYLOR J PETERSON (PA-C) – Physician Assistant, NPI 1962024265
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
2,499 PHYSICIAN ASSISTANT in IN
Provider Addresses for TAYLOR J PETERSON (PA-C)
4461 E 150 S
LAGRO, IN 469419432
Phone: (260) 571-8608
Type: Mailing
602 W Redskin Trl
Wapakoneta, OH 458959349
Phone: (419) 998-8276
Fax: (419) 998-8277
Type: Location
1001 BELLEFONTAINE AVE
LIMA, OH 458042800
Phone: (419) 998-4575
Fax: (419) 998-4586
Type: Mailing
1005 BELLEFONTAINE AVE STE 225
LIMA, OH 458042896
Phone: (419) 998-8276
Fax: (419) 998-8277
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 36 Open Payments records for all available years, with a total value of $696.
Total Amount is formed as General ($696) + Research ($0) + Ownership ($0) = $696.
Last reported payment date: 2024-12-03 • Largest payer in this snapshot: Sumitomo Pharma America, Inc. ($198).
Total Amount
$696
General + Research + Ownership
Payments
36
Total payment records
General Amount
$696
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-03
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Sumitomo Pharma America, Inc. | $198 |
| UROGEN PHARMA, INC. | $45 |
| Axonics, Inc. | $39 |
| Medtronic, Inc. | $38 |
| Ambu Inc. | $33 |
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: 2021-04-12
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 |
|---|---|---|---|---|
| I20210412002241 | I | Physician Assistant | OH | 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 46941)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Radiation Oncology | OH | |
| - | OH | |
| Family Practice | OH | |
| Physician Assistant | OH | |
| Physician Assistant | OH | |
| Physician Assistant | OH | |
| Nurse Practitioner | OH | |
| Internal Medicine | OH | |
| Colorectal Surgery (Proctology) | OH | |
| Physician Assistant | OH |
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