GLENN ADAM PETERSON (PA-C) – Physician Assistant, NPI 1972031698
Physician Assistant
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Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
4,282 PHYSICIAN ASSISTANT in WA
Provider Addresses for GLENN ADAM PETERSON (PA-C)
28595 GAMBLE BAY RD NE
KINGSTON, WA 983469503
Phone: (618) 550-9746
Type: Mailing
19835 10TH AVE NE STE B
POULSBO, WA 983707451
Phone: (360) 779-7011
Type: Location
412 S. Jackson St.
Belleville, IL 62220
Phone: (618) 550-9746
Type: Location
939 Caroline St
Port Angeles, WA 983623997
Phone: (360) 417-7000
Type: Location
4500 Memorial Dr
Belleville, IL 622265360
Phone: (618) 233-7750
Type: Location
412, South Jackson Street, Belleville, Saint Clair County, Illinois, 62220, United States
BELLEVILLE, IL 622202259
Phone: (618) 550-9746
Type: Mailing
Memorial Hospital, 4500, Memorial Drive, Royal Heights, Belleville, Saint Clair County, Illinois, 62226, United States
BELLEVILLE, IL 622265360
Phone: (618) 233-7750
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
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: 2020-06-10
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 |
|---|---|---|---|---|
| I20170802002074 | I | Physician Assistant | IL | TBD |
| I20200610003524 | I | Physician Assistant | WA | 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 |
|---|---|---|---|---|
| 93042 | Electrocardiogram (ecg) 1 to 3 leads with review by physician only | 64 | 63 | $0 |
| 99284 | Emergency department visit with moderate level of medical decision making | 50 | 50 | $0 |
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | 48 | 48 | $0 |
| 93010 | Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only | 32 | 27 | $0 |
| 99291 | Critical care, first 30-74 minutes | 17 | 17 | $0 |
Insurance plans in this area (ZIP 98346)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | WA | |
| Emergency Medicine | WA | |
| Emergency Medicine | VA | |
| - | WA | |
| Emergency Medicine | MO | |
| Emergency Medicine | SC | |
| Emergency Medicine | MI | |
| Emergency Medicine | WA | |
| Emergency Medicine | NY | |
| Emergency Medicine | NM |
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