Russel Peterson, is a medicare enrolled "Physical Therapist" provider in Snowflake, Arizona. He graduated from medical school in 1996 and has 28 years of diverse experience with area of expertise as Physical Therapy. He is a member of the group practice White Mountain Physical Therapy Ltd and his current practice location is
420 S Main St, Snowflake, Arizona. You can reach out to his office (for appointments etc.) via phone at
(928) 536-2357.
Russel Peterson is licensed to practice in Arizona (license number 3705) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1063444933.
Healthcare Provider's Profile
| Full Name | Russel Peterson |
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| Gender | Male |
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| Speciality | Physical Therapy |
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| Experience | 28 Years |
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| Location | 420 S Main St, Snowflake, Arizona |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Russel Peterson graduated from medical school in 1996
NPI Data:
- NPI Number: 1063444933
- Provider Enumeration Date: 07/07/2006
- Last Update Date: 10/24/2007
Medicare PECOS Information:
- PECOS PAC ID: 1456498328
- Enrollment ID: I20110119000600
Medical Identifiers
Medical identifiers for Russel Peterson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1063444933 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 225100000X | Physical Therapist | 3705 (Arizona) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| White Mountain Physical Therapy Ltd | 0446142111 | 11 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Russel Peterson allows following entities to bill medicare on his behalf.
| Provider Name | White Mountain Physical Therapy Ltd |
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| Provider Type | Part B Supplier - Clinic/group Practice |
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| Provider Identifiers | NPI Number: 1750385654
PECOS PAC ID: 0446142111
Enrollment ID: O20040326001159 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Russel Peterson is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Russel Peterson,
2650 E Show Low Lake Rd, Suite 3,
Show Low, AZ 85901-7955
Ph: () - | Russel Peterson,
420 S Main St,
Snowflake, AZ 85937-5246
Ph: (928) 536-2357 |
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