Physician Compare National (NPI:1972630564)

HEALTHCARE PROVIDER: DANIEL L PETERSON MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1972630564
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9638194640
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20051010000279
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	PETERSON
	Individual professional last name
Provider First Name	DANIEL
	Individual professional first name
Provider Middle Name	L
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	UNIVERSITY OF ROCHESTER SCHOOL OF MEDICINE AND DENTISTRY
	Individual professional's medical school
Graduation Year	1976
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	926 INCLINE WAY
	Group Practice or individual's line 1 address
Line 2 Street Address	UNIT 250
	Group Practice or individual's line 2 address
City	INCLINE VILLAGE
	Group Practice or individual's city
State	NV
	Group Practice or individual's state
Zip Code	894518425
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7758324886
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	291301
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	INCLINE VILLAGE HEALTH CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	290019
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	CARSON TAHOE REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	051328
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	TAHOE FOREST HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	290001
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	RENOWN REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 4
Hospital Affiliation CCN 5	290009
	Medicare CCN of hospital where individual professional provides service 5
Hospital Affiliation LBN 5	SAINT MARY'S REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 5
Professional Accepts Medicare Assignment	Y

Physician Compare National (NPI:1972630564)

HEALTHCARE PROVIDER: DANIEL L PETERSON MD

Individual Professional Information

Medical School Information

Practice Information

Hospital(s) Affiliation Information