Jayanthi Krishnamoorthy Peters, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

4301106462 Issued in MI

Practice address

300 68TH St SE
Grand Rapids, MI 49548-6927

Phone

(616) 559-5896

NPI assigned

Mar 20, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 2

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2016 through Jan 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jayanthi.peters.1@10474.direct.athenahealth.com

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.

• Einstein Practice Plan Inc

  • Psychiatry Physician
  • Philadelphia, PA
  • NPI 1144272733
  NPD (past)
• Indiana University Psychiatric Associates, Inc.

  • Psychiatry Physician
  • Indianapolis, IN
  • NPI 1023063724
  NPD (past)

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712707200000",
    "number": "1073638227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N SHADELAND AVE",
            "address_2": "SUITE 130",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 68TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495486927",
            "telephone_number": "616-559-5896"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "97 S 4th St Ste A",
            "address_purpose": "LOCATION",
            "city": "Ishpeming",
            "state": "MI",
            "postal_code": "498492168",
            "country_code": "US",
            "telephone_number": "906-485-2347",
            "fax_number": "906-486-1150",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "703 Pro-Med Ln",
            "address_purpose": "LOCATION",
            "city": "Carmel",
            "state": "IN",
            "postal_code": "460325317",
            "country_code": "US",
            "telephone_number": "317-843-9922",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "790 Fuller Ave NE",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495031918",
            "country_code": "US",
            "telephone_number": "616-336-3909",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERS",
        "first_name": "JAYANTHI",
        "middle_name": "KRISHNAMOORTHY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-20",
        "last_updated": "2024-04-10",
        "certification_date": "2024-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OH",
            "license": "35084122",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "OH",
            "license": "35084122",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IN",
            "license": "01070092A",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "4301106462",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201032310",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000735742",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "PineRestCMHS@directaddress.pinerest.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "300 68th St SE",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495486927",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Pcerecords.network180.x@direct.mihin.net",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "790 Fuller Ave NE",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495031918",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Peters Family Dentistry, PLLC
• Abigail Peters
• Alyson Peters
• Daniel Joseph Peters, DDS
• Debra Peters, DDS
• Kara Peters
• Raneithiah Peters
• Robert J Peters, OD
• Ryan A Peters, DO
• Courtney Petersen

• Psychiatry Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Psychiatry Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2024; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.