Active NPI
Jayme M Peterson, PAC
- Physician Assistant
- Melbourne, FL
National Provider Identifier
1063588135
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA 9103306
- Practice address
- 2080 W Eau Gallie Blvd
Suite a
Melbourne, FL 32935-3185 - Phone
- (321) 254-6218
- Fax
- (321) 254-6230
- NPI assigned
- Nov 28, 2006
- Last updated
- Feb 15, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA 9103306 | FL | Primary |
Addresses
Primary practice location
2080 W Eau Gallie Blvd
Suite a
Melbourne, FL 32935-3185
Mailing address
PO Box 361907
Melbourne, FL 32936-1907
Phone (321) 254-6218
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA 9103306 | FL | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brevard Emergency Services | Past | Accepting new patients | |
| Space Coast Health Care Services | Past | Accepting new patients |
Interoperability endpoints
- jpeterson71400@epicdirect.hf.org
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Anesthesiology Physician
- Melbourne, FL
- NPI 1598008955
-
dba Surfside Urgent Care
- Urgent Care Clinic/Center
- Indialantic, FL
- NPI 1952687923
-
- Internal Medicine Physician
- Melbourne, FL
- NPI 1104870393
-
- Internal Medicine Physician
- Melbourne, FL
- NPI 1144274358
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164672000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1329264000000",
"number": "1063588135",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 361907",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329361907",
"telephone_number": "321-254-6218",
"fax_number": "321-254-6230"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2080 W EAU GALLIE BLVD",
"address_2": "SUITE A",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329353185",
"telephone_number": "321-254-6218",
"fax_number": "321-254-6230"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "JAYME",
"middle_name": "M",
"credential": "PAC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-28",
"last_updated": "2012-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA 9103306",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Melbourne, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.