NPIMap

Individual provider Active NPI

Jared David Peterson

  • Ophthalmology Physician
  • Loveland, CO
National Provider Identifier
1053904672
Registry record updated Jul 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
MD224449 Issued in OR
Practice address
5250 Hahns Peak Dr Ste 180
Loveland, CO 80538-8712
Phone
(303) 772-3300
Fax
(303) 682-3380
NPI assigned
Feb 15, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X MD224449 OR Primary

Addresses

Primary practice location

5250 Hahns Peak Dr Ste 180
Loveland, CO 80538-8712

Mailing address

Department of Ophthalmology Medical Center Blvd
Winston Salem, NC 27157-0001

Other practice location 1

Medical Center Boulevard
Winston Salem, NC 27157-0001
Phone (336) 716-3971

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250417000790 OR Practitioner - Ophthalmology 0042627457 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
University of Iowa, RJ & L Carver College of Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Legacy Good Samaritan Hospital and Medical CenterGroup PAC ID 0547179939, 190 clinicians

Practice addresses (Care Compare)

1040 NW 22ND Ave
Suite 168
Portland, OR 97210-3036
Phone (503) 413-7022

Hospital & facility affiliations

  • Legacy Good Samaritan Medical Center Hospital, Portland, OR, CCN 380017
  • Legacy Emanuel Medical Center Hospital, Portland, OR, CCN 380007

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD224449ORMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Emanuel Hospital & Health Center CurrentSince Apr 8, 2025 Accepting new patients
Legacy Emanuel Hospital & Health Center Current Accepting new patients
Legacy Good Samaritan Hospital and Medical Center Current Accepting new patients
Legacy Good Samaritan Hospital and Medical Center CurrentSince Apr 8, 2025 Accepting new patients
Legacy Good Samaritan Hospital and Medical Center CurrentSince Apr 8, 2025 Accepting new patients
Legacy Emanuel Hospital & Health Center CurrentSince Apr 8, 2025 Accepting new patients

Locations

2801 N Gantenbein Ave
Portland, OR 97227
Phone (503) 413-2200

1040 NW 22nd Ave
Ste 168
Portland, OR 97210
Phone (503) 413-7022

1919 NW Lovejoy St
Portland, OR 97209
Phone (503) 415-5600

300 N Graham St
Ste 300
Portland, OR 97227
Phone (503) 280-3620

1200 NW 23rd Ave
Portland, OR 97210
Phone (503) 413-7074

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1613347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783555200000",
    "number": "1053904672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPARTMENT OF OPHTHALMOLOGY MEDICAL CENTER BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271570001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5250 HAHNS PEAK DR STE 180",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805388712",
            "telephone_number": "303-772-3300",
            "fax_number": "303-682-3380"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Medical Center Boulevard",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271570001",
            "country_code": "US",
            "telephone_number": "336-716-3971",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JARED",
        "middle_name": "DAVID",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-02-15",
        "last_updated": "2026-07-09",
        "certification_date": "2026-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "OR",
            "license": "MD224449",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loveland, CO

Sources for this page

Verify at the official NPI Registry.