ANDREA RAE PETERSEN (MPH, PA-C) – Physician Assistant, NPI 1063854669
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
4,031 PHYSICIAN ASSISTANT in MN
Provider Addresses for ANDREA RAE PETERSEN (MPH, PA-C)
17 EXCHANGE ST W
SUITE 622
SAINT PAUL, MN 551021045
Phone: (651) 227-9141
Type: Mailing
14655 GALAXIE AVE
APPLE VALLEY, MN 551248575
Phone: (651) 227-9141
Type: Location
500 SUPERIOR AVE STE 310
NEWPORT BEACH, CA 926633609
Phone: (949) 644-2722
Fax: (949) 650-3135
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 4 Open Payments records for all available years, with a total value of $59.
Total Amount is formed as General ($59) + Research ($0) + Ownership ($0) = $59.
Last reported payment date: 2024-02-20 • Largest payer in this snapshot: Exeltis, USA Inc. ($32).
Total Amount
$59
General + Research + Ownership
Payments
4
Total payment records
General Amount
$59
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-02-20
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Exeltis, USA Inc. | $32 |
| PFIZER INC. | $13 |
| CooperSurgical, Inc. | $13 |
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: 2024-11-12
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
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 |
|---|---|---|---|---|
| I20150108001947 | I | Physician Assistant | MN | TBD |
| I20241112001229 | I | Physician Assistant | CA | 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 55102)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| O B S T E T R I C S/ G Y N E C O L O G Y | CA | |
| Family Practice | CA | |
| Family Practice | VA | |
| General Surgery | CA | |
| O B S T E T R I C S/ G Y N E C O L O G Y | CA | |
| O B S T E T R I C S/ G Y N E C O L O G Y | CA | |
| O B S T E T R I C S/ G Y N E C O L O G Y | CA | |
| Family Practice | CA | |
| Physician Assistant | CA | |
| Physician Assistant | CA |
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