Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Matthew R Peterson, PA

Individual provider Emergency Medicine Physician · NPI 1285745711

Matthew R Peterson, PA is a Physician Assistant in Saint Louis, Missouri. Qualified in 2006, 20 years ago. Practices with Vituity - Illinois Auc LLP, a 34-clinician group and accepts Medicare assignment. Licensed in Illinois and Missouri.

Years since qualifying
20
Licensed in
IL, MO
In the registry since
2006
Specialties on file
3
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

10010 Kennerly Rd
Saint Louis, MO 63128-2106
Phone: (314) 525-1911
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 85-002763 (IL)
Emergency Medicine Physician Taxonomy 207P00000X · Licence 085-002763 (IL)
Physician Assistant Taxonomy 363A00000X · Licence 2008025807 (MO)

Record details

NPI number1285745711
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedAugust 31, 2006
Last updated in NPPESNovember 15, 2019

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2006 (20 years in practice)
Group practice Vituity - Illinois Auc Llp — 34 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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