DR. RANDOLPH K. PETERSON (M.D.) – Anatomic Pathology & Clinical Pathology Physician, NPI 1053380204
Anatomic Pathology & Clinical Pathology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
518 PATHOLOGY in MN
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Provider Addresses for DR. RANDOLPH K. PETERSON (M.D.)
Southdale Medical Building, 6525, France Avenue South, Southdale, Edina, Hennepin County, Minnesota, 55435, United States
SUITE 200
EDINA, MN 554352148
Phone: (952) 927-6501
Fax: (952) 653-1435
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 2 Open Payments records for all available years, with a total value of $187.
Total Amount is formed as General ($187) + Research ($0) + Ownership ($0) = $187.
Last reported payment date: 2024-02-21 • Largest payer in this snapshot: CONMED Corporation ($138).
Total Amount
$187
General + Research + Ownership
Payments
2
Total payment records
General Amount
$187
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-02-21
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| CONMED Corporation | $138 |
| Telix Pharmaceuticals | $48 |
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: 2009-02-04
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 |
|---|---|---|---|---|
| I20090204000093 | I | Pathology | MN | 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 |
|---|---|---|---|---|
| 88344 | Special stained specimen slides to examine tissue, each multiplex procedure | 238 | 114 | $0 |
| G0416 | Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method | 196 | 193 | $0 |
Insurance plans in this area (ZIP 55435)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | MN | |
| Physician Assistant | MN | |
| U R O L O G Y | MN | |
| Physician Assistant | MN | |
| Diagnostic Radiology, Interventional Radiology | IA | |
| - | MN | |
| U R O L O G Y | MN | |
| Physician Assistant | MN | |
| U R O L O G Y | MN | |
| U R O L O G Y | MN |
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