Active NPI
Jason R Peterson, R D
- Renal Nutrition Registered Dietitian
- Des Moines, IA
National Provider Identifier
1073668000
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Renal Nutrition Registered Dietitian
- License
- 01563
- Practice address
- 1111 6TH Ave
Suite 510
Des Moines, IA 50314-2610 - Phone
- (515) 643-5275
- Fax
- (515) 643-5276
- NPI assigned
- Jan 23, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Renal Nutrition Registered Dietitian | 133VN1005X | 01563 | IA | Primary |
Addresses
Primary practice location
1111 6TH Ave
Suite 510
Des Moines, IA 50314-2610
Mailing address
2213 Grand Ave
Des Moines, IA 50312-5305
Phone (515) 237-3974
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01563 | IA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1073668000",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2213 GRAND AVE",
"city": "DES MOINES",
"state": "IA",
"postal_code": "503125305",
"telephone_number": "515-237-3974",
"fax_number": "515-883-2692"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1111 6TH AVE",
"address_2": "SUITE 510",
"city": "DES MOINES",
"state": "IA",
"postal_code": "503142610",
"telephone_number": "515-643-5275",
"fax_number": "515-643-5276"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "JASON",
"middle_name": "R",
"credential": "R D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133VN1005X",
"taxonomy_group": "",
"desc": "Dietitian, Registered, Nutrition, Renal",
"state": "IA",
"license": "01563",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Des Moines, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.