Active NPI
Jonathan Pederson, DO
- Family Medicine Physician
- Tacoma, WA
National Provider Identifier
1164446050
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- DOS 1119
- Practice address
- Madigan Army Medical Center
9040 Jackson Ave
Tacoma, WA 98431-0001 - Phone
- (253) 968-2252
- NPI assigned
- Jul 26, 2006
- Last updated
- Jan 6, 2026
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | DOS 1119 | HI | Primary |
Addresses
Primary practice location
Madigan Army Medical Center
9040 Jackson Ave
Tacoma, WA 98431-0001
Mailing address
Madigan Army Medical Center
9040 Jackson Ave
Tacoma, WA 98431-0001
Phone (253) 968-2252
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| VAD000 | Other | HI | UPN |
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
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DOS 1119 | HI | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1767657600000",
"number": "1164446050",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "MADIGAN ARMY MEDICAL CENTER",
"address_2": "9040 JACKSON AVE",
"city": "TACOMA",
"state": "WA",
"postal_code": "984310001",
"telephone_number": "253-968-2252"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "MADIGAN ARMY MEDICAL CENTER",
"address_2": "9040 JACKSON AVE",
"city": "TACOMA",
"state": "WA",
"postal_code": "984310001",
"telephone_number": "253-968-2252"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEDERSON",
"first_name": "JONATHAN",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-26",
"last_updated": "2026-01-06",
"certification_date": "2026-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "HI",
"license": "DOS 1119",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UPN",
"identifier": "VAD000",
"state": "HI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.