MARY T CARR PETERSON (PA) – Physician Assistant, NPI 1164496212
Physician Assistant
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Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
1,649 PHYSICIAN ASSISTANT in IA
Provider Addresses for MARY T CARR PETERSON (PA)
7147 VISTA DR STE 150
WEST DES MOINES, IA 502669317
Phone: (515) 875-9925
Fax: (515) 875-9923
Type: Mailing
1410 SW Tradition Dr Ste 120
Ankeny, IA 500239188
Phone: (515) 875-9040
Fax: (515) 875-9041
Type: Location
Southwest Tradition Drive, Ankeny, Polk County, Iowa, 50023-9723, United States
ANKENY, IA 50023
Phone: (515) 875-9696
Fax: (515) 875-9697
Type: Location
PO BOX 424
DES MOINES, IA 503020424
Phone: (515) 875-9255
Fax: (515) 875-9223
Type: Mailing
1410 SW TRADITION DR STE 120
ANKENY, IA 500239188
Phone: (515) 875-9040
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $17.
Total Amount is formed as General ($17) + Research ($0) + Ownership ($0) = $17.
Last reported payment date: 2024-03-05 • Largest payer in this snapshot: ABBVIE INC. ($17).
Total Amount
$17
General + Research + Ownership
Payments
1
Total payment records
General Amount
$17
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-03-05
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ABBVIE INC. | $17 |
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: 2005-01-10
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 |
|---|---|---|---|---|
| I20050110000938 | I | Physician Assistant | IA | 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 | 149 | 114 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 140 | 109 | $0 |
| 36415 | Insertion of needle into vein for collection of blood sample | 114 | 95 | $0 |
| 80053 | Blood test, comprehensive group of blood chemicals | 92 | 82 | $0 |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | 72 | 65 | $0 |
Insurance plans in this area (ZIP 50266)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | IA | |
| Nurse Practitioner | IA | |
| Nurse Practitioner | IA | |
| Family Practice | IA | |
| Nurse Practitioner | IA | |
| Physician Assistant | IA | |
| Nurse Practitioner | IA | |
| Nurse Practitioner | IA | |
| Family Practice | IA | |
| - | IA |
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