CARLOTTA PETERSEN (PA) – Physician Assistant, NPI 1417288911
Physician Assistant
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Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
8,491 PHYSICIAN ASSISTANT in TX
Provider Addresses for CARLOTTA PETERSEN (PA)
6750 N MACARTHUR BLVD STE 270
IRVING, TX 750392469
Phone: (877) 314-8990
Fax: (844) 364-3321
Type: Mailing
500 W MAIN ST STE 200
LEWISVILLE, TX 750573639
Phone: (877) 314-8990
Type: Location
6750 N MacArthur Blvd Ste 270
Irving, TX 750392469
Phone: (877) 314-8990
Type: Location
1050 E. Hwy. 114
Suite 100
Southlake, TX 760925242
Phone: (817) 329-8364
Fax: (817) 329-1285
Type: Location
Northwest Highway, Southlake, Tarrant County, Texas, 76051, United States
SUITE 100
SOUTHLAKE, TX 760925242
Phone: (817) 329-8364
Fax: (817) 329-1285
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 30 Open Payments records for all available years, with a total value of $950.
Total Amount is formed as General ($950) + Research ($0) + Ownership ($0) = $950.
Last reported payment date: 2024-08-15 • Largest payer in this snapshot: Medtronic, Inc. ($782).
Total Amount
$950
General + Research + Ownership
Payments
30
Total payment records
General Amount
$950
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-08-15
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Medtronic, Inc. | $782 |
| SI-BONE, INC. | $75 |
| Orthofix Medical, Inc. | $59 |
| Kowa Pharmaceuticals America, Inc. | $17 |
| DePuy Synthes Sales 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: 2021-04-30
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 |
|---|---|---|---|---|
| I20210430000161 | I | Physician Assistant | TX | 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 | 34 | 31 | $0 |
| 72100 | X-ray of lower and sacral spine, 2-3 views | 30 | 19 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 27 | 21 | $0 |
| 72110 | X-ray of lower and sacral spine, minimum of 4 views | 22 | 22 | $0 |
| 99215 | Established patient office or other outpatient visit, 40-54 minutes | 18 | 17 | $0 |
Insurance plans in this area (ZIP 75039)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Orthopedic Surgery | TX | |
| Physician Assistant | TX | |
| Orthopedic Surgery | NC | |
| Nurse Practitioner | TX | |
| Orthopedic Surgery | TX | |
| - | TX | |
| Physician Assistant | TX | |
| Orthopedic Surgery | TX | |
| - | TX | |
| Orthopedic Surgery | TX |
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