Individual provider Active NPI

Jameson Ross Petersen

  • Rheumatology Physician
  • St George, UT
National Provider Identifier
1104289123
Registry record updated Aug 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rheumatology PhysicianTaxonomy code 207RR0500X
License
12137452-1205 Issued in UT
Practice address
544 S 400 E
St George, UT 84770-3705
Phone
(435) 688-6200
NPI assigned
Mar 29, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rheumatology Physician 207RR0500X 12137452-1205 UT Primary

Addresses

Primary practice location

544 S 400 E
St George, UT 84770-3705

Mailing address

544 S 400 E
St George, UT 84770-3705
Phone (435) 688-6200

Other practice location 1

4860 Y St Ste A
Sacramento, CA 95817-2307
Phone (916) 734-2812

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210816004119 UT Practitioner - RheumatologyPractitioner - Internal Medicine 9739473042 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
RheumatologyAlso: Internal Medicine
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Practice addresses (Care Compare)

544 S 400
St George, UT 84770-3705
Phone (435) 688-4700

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
12137452-1205UTMDRheumatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services Inc CurrentSince Aug 31, 2021 Accepting new patients
Ihc Health Services, Inc. CurrentSince Aug 31, 2021 Accepting new patients
Ihc Health Services Inc Current Accepting new patients
Ihc Health Services Inc Past Accepting new patients
Regents of the Univ of Ca Past Accepting new patients

Locations

700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555

544 S 400 E
St George, UT 84770
Phone (435) 688-4000

577 S River Rd
St George, UT 84790
Phone (435) 688-6000

Organizations & group practices 5

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 3

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": "1459209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629244800000",
    "number": "1104289123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "544 S 400 E",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847703705",
            "telephone_number": "435-688-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "544 S 400 E",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847703705",
            "telephone_number": "435-688-6200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4860 Y St Ste A",
            "address_purpose": "LOCATION",
            "city": "Sacramento",
            "state": "CA",
            "postal_code": "958172307",
            "country_code": "US",
            "telephone_number": "916-734-2812",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "JAMESON",
        "middle_name": "ROSS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-29",
        "last_updated": "2021-08-18",
        "certification_date": "2021-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "UT",
            "license": "12137452-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St George, UT

Sources for this page

Verify at the official NPI Registry.