Type 1 · Individual ✓ Active NPI ✓ Valid NPI checksum Sole proprietor
Dr. Joseph R Petersen
Specialist in Burley, ID · enumerated 2006.
Data current as of Jul 13, 2026 · sourced from CMS NPPES
National Provider Identifier
1225105604
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Registry record
Street address withheld: NPPES sole-proprietor addresses can be home addresses. See our data policy.
Taxonomy & licenses
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000010003563 | Other | ID | BLUE SHIELD PROVIDER NO. |
| C36979 | Other | ID | DMBA |
| 014917 | Other | ID | SELECTCARE |
| I000490 | Other | ID | TRICARE |
| 74096 | Other | ID | BLUE CROSS PROVIDER NUMBE |
| 0791870001 | Other | ID | MEDICARE DMERC |
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.
Frequently asked questions
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Other providers at this practice address
Browse all →Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2007-07-09.