Jacquelyn Peterson

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

007012 Issued in NY

Practice address

320 Prather Ave
Jamestown, NY 14701-6820

Phone

(716) 753-7107

NPI assigned

Nov 1, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Great Lakes Physician Practice PC

  • Internal Medicine Physician
  • Jamestown, NY
  • NPI 1730599176
  Medicare reassignment
• Jamestown Area Medical Associates, L.L.P.

  • Internal Medicine Physician
  • Jamestown, NY
  • NPI 1528010766

  Medical

  NPD

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

{
    "created_epoch": "1130803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623715200000",
    "number": "1124019948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95 E CHAUTAUQUA ST",
            "address_2": "PO BOX 168",
            "city": "MAYVILLE",
            "state": "NY",
            "postal_code": "147571017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 PRATHER AVE",
            "city": "JAMESTOWN",
            "state": "NY",
            "postal_code": "147016820",
            "telephone_number": "716-753-7107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JACQUELYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-01",
        "last_updated": "2021-06-15",
        "certification_date": "2021-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "007012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "upmchospitals@upmcdirect.com",
            "affiliation": "Y",
            "affiliationName": "UPMC",
            "address_1": "600 Grant St",
            "address_2": "Floor 58",
            "city": "Pittsburgh",
            "state": "PA",
            "country_code": "US",
            "postal_code": "152192702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Tisha Renee Percell, LPN
• Julia L Perkins, RDH
• Thomas Perry
• Albert Persia, M.D.
• Hunter Peterson
• Lauraine Alice Peterson
• Michael Carl Peterson, P.T.
• Nikki Michele Peterson, CNM
• Jennifer Rae Phillips, MS, CCC-SLP/L
• Anne Piazza, SOCIAL WORKER

• Medical Physician Assistant in Jamestown, NY
• Providers in Jamestown, NY by specialty
• Medical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2021; 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.

Verify at the official NPI Registry.