Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1700377124 Individual Practitioner Female Practitioner

Dr. Antonique Peterson , DO

General Practice • Minneapolis, MN

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. Antonique Peterson, DO is a certified General Practice practicing in Minneapolis, MN. With approximately 8 years of clinical experience since graduating from Arizona College Of Osteopathic Medicine Mid Western University in 2018, Dr. Peterson delivers high-quality medical care to the local community at 1313 PENN AVE N.

Dr. Peterson is affiliated with Emory Physicians Group, Llc and accepts Medicare assignment.

Practice Location & Contact Primary Location

Practice Address

1313 Penn Ave N

Minneapolis, MN 554113047

Telephone 6125432500
Associated Practice Facility / Clinic
🏢 Pillsbury United Communities Facility NPI 1912064312

Medicare Profile & Education

Medical School

Arizona College Of Osteopathic Medicine Mid Western University

Graduation Year

2018

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for General Practice in Minneapolis, MN

Experienced Practitioner (5-10 Yrs)
Practitioner Clinical Experience
8 Yrs -8.8 yrs vs City Avg
City Avg: 16.8 Yrs
State Avg: 19.4 Yrs
Regional Practice Density
19 Specialists

Practicing in Minneapolis, MN (95 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Peterson (8 Years) 8 Yrs
Minneapolis Specialty Average (16.8 Years) 16.8 Yrs

Medical Specialties & State Licenses

CMS Verified: 2021-10-27
General Practice Primary Specialty

NUCC Taxonomy Code: 208D00000X

State License MN 69440

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.

Student in an Organized Health Care Education/Training Program

NUCC Taxonomy Code: 390200000X

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
416005801 (MN)

Hospital & Practice Group Affiliations

Emory Physicians Group, Llc

1311 Johnson Ferry Rd, Marietta, GA 300682947

Phone: 8886636331

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners
Dr. Joshua Sabin , PsyD, LP

Psychologist - Clinical

NPI 1013358688

Doctor of Psychology (Psy.D.), Licensed Psychologist

Lanette Howze

Community Health Worker

NPI 1013477348
Yeezong Vang , LPCC

Counselor - Professional

NPI 1043056831

Licensed Professional Clinical Counselor

Ncha Xiong

Family Medicine

NPI 1053555987
Oluyomi Alowooja , LPCC

Counselor - Mental Health

NPI 1063181212

Licensed Professional Clinical Counselor

NPI 1063671782

Doctor of Psychology (Psy.D.), Licensed Professional Clinical Counselor

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

8 Historical Events
📍
Updated Practice Location October 27, 2021

Registered at 1313 PENN AVE N, MINNEAPOLIS, MN 554113047 (Tel: 6125432500)

📍
Updated Business Mailing Address October 27, 2021

Registered at 1313 PENN AVE N, MINNEAPOLIS, MN 554113047 (Tel: 6125432582)

NPI Profile Active May 21, 2018

NPI status registered as active in NPPES database

📍
Updated Practice Location May 21, 2018

Registered at 350 W THOMAS RD, PHOENIX, AZ 850134409 (Tel: 6024063153)

📍
Updated Business Mailing Address May 21, 2018

Registered at 350 W THOMAS RD, PHOENIX, AZ 850134409 (Tel: 6024063153)

👤
Provider Name / Credentials Updated May 21, 2018

Recorded as ANTONIQUE PETERSON, DO

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) May 21, 2018

Student in an Organized Health Care Education/Training Program

🟢
Initial NPI Registration & Enumeration May 21, 2018

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1700377124
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: May 21, 2018
Last Update: October 27, 2021
Sole Proprietor: No

Mailing Address

1313 Penn Ave N

Minneapolis, MN 554113047

Phone: 6125432582

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.