ANDREA RAE PETERSEN MPH PA-C NPI 1063854669

NPI Information

  • NPI: 1063854669
  • Provider Name: ANDREA RAE PETERSEN, MPH, PA-C
  • Classification: Physician Assistant - 363A00000X
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 1809 NATIONAL AVE
    SAN DIEGO, CA
    ZIP 92113
  • Phone: (619) 515-2300

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NPI Details

Andrea Rae Petersen, MPH, PA-C is a physician assistant in San Diego, CA with 12 years of experience. The provider is a physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. Andrea Rae Petersen, MPH, PA-C NPI is 1063854669. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1809 NATIONAL AVE
SAN DIEGO, CA
ZIP 92113-113
Phone: (619) 515-2300

The NPI 1063854669 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Automated urinalysis test (HCPCS:81003)
  • Detection test for candida species (yeast), direct probe technique (HCPCS:87480)
  • Detection test for gardnerella vaginalis (bacteria), direct probe technique (HCPCS:87510)
  • Detection test by nucleic acid for trichomonas vaginalis (genital parasite), direct probe technique (HCPCS:87660)

The enumeration date for this NPI number is 7/24/2013 and was last updated on 11/11/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363A00000XPhysician Assistant11722MINNESOTANo
2363A00000XPhysician Assistant65363CALIFORNIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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