Dr Letty Revell Peterson, MD is a medicare enrolled "Dermatology" physician in Vidalia, Georgia. She went to Medical College Of Georgia School Of Medicine and graduated in 2007 and has 17 years of diverse experience with area of expertise as Dermatology. She is a member of the group practice Peterson Dermatology, P.c. and her current practice location is
305 First St. West, Vidalia, Georgia. You can reach out to her office (for appointments etc.) via phone at
(912) 538-9080.
Dr Letty Revell Peterson is licensed to practice in Georgia (license number 058913) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1760507974.
Physician's Profile
| Full Name | Dr Letty Revell Peterson |
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| Gender | Female |
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| Speciality | Dermatology |
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| Experience | 17 Years |
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| Location | 305 First St. West, Vidalia, Georgia |
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| Accepts Medicare Assignments | Yes. She 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:
- Dr Letty Revell Peterson attended and graduated from Medical College Of Georgia School Of Medicine in 2007
NPI Data:
- NPI Number: 1760507974
- Provider Enumeration Date: 03/20/2007
- Last Update Date: 10/22/2012
Medicare PECOS Information:
- PECOS PAC ID: 9830280056
- Enrollment ID: I20070802000205
Medical Identifiers
Medical identifiers for Dr Letty Revell Peterson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1760507974 | NPI | - | NPPES |
| 551383524A | Medicaid | GA | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 207N00000X | Dermatology | 058913 (Georgia) | Primary |
| 207ND0101X | Dermatology - Mohs-micrographic Surgery | 058913 (Georgia) | Secondary |
| 207NP0225X | Dermatology - Pediatric Dermatology | 058913 (Georgia) | Secondary |
| 207NS0135X | Dermatology - Procedural Dermatology | 058913 (Georgia) | Secondary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|
| Peterson Dermatology, P.c. | 7113018334 | 4 |
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. Dr Letty Revell Peterson allows following entities to bill medicare on her behalf.
| Entity Name | Peterson Dermatology, P.c. |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1932300886
PECOS PAC ID: 7113018334
Enrollment ID: O20070802000182 |
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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. Dr Letty Revell 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 |
|---|
Dr Letty Revell Peterson, MD
305 First St. West,
Vidalia, GA 30474-7201
Ph: (912) 538-9080 | Dr Letty Revell Peterson, MD
305 First St. West,
Vidalia, GA 30474-7201
Ph: (912) 538-9080 |
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