Jacob Mason Peters, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12668 Issued in MN

Practice address

1011 Bel Air LN NW
Rochester, MN 55901-6992

Phone

(507) 288-1188

Fax

(507) 529-4065

NPI assigned

Jun 16, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

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

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Family Dentist Tree, PA

  • General Practice Dentistry
  • Rochester, MN
  • NPI 1972636777
  NPD (past)

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

{
    "created_epoch": "1245110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245110400000",
    "number": "1154558252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 BEL AIR LN NW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559016992",
            "telephone_number": "507-288-1188",
            "fax_number": "507-529-4065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 BEL AIR LN NW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559016992",
            "telephone_number": "507-288-1188",
            "fax_number": "507-529-4065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERS",
        "first_name": "JACOB",
        "middle_name": "MASON",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-16",
        "last_updated": "2009-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "12668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Candy S Peskey, PHARMD BCPS
• Elizabeth L. Pestka
• Amanda Lou Peters
• Angela Elizabeth Peters, R.N.
• Brooke S. Peters, PA-C
• Jonathan Claire Agin Peters, DO
• Julian Peters, RPH
• Margot Szasz Peters, MD
• Sonya Peters, PA-C
• Steve G Peters, M.D.

• General Practice Dentistry in Rochester, MN
• Providers in Rochester, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2009; 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.