Jeffry Lynes Peterson, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

3002489 Issued in KY

Practice address

10117 Pine Crest Rd
Red Bud, IL 62278-4458

Phone

(618) 282-2872

NPI assigned

Jan 31, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL, MO2 enrollments

Enrollment records 2

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Memorial HospitalGroup PAC ID 5294649372, 29 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Memorial Hospital Hospital, Chester, IL, CCN 141338

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-usa.unify.chbase.com/org/sparta-7b261c4f
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• Direct secure messaging: ehr-direct@spartahospital.hin.us

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.

• Memorial Hospital

  • Critical Access Hospital
  • Chester, IL
  • NPI 1851390132

  IL, Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• Sparta Community Hospital

  • Critical Access Hospital
  • Sparta, IL
  • NPI 1548216476

  IL

  Medicare reassignment NPD
• Sparta Community Hospital D/B/a Quality Healthcare Clinics

  • Multi-Specialty Clinic/Center
  • Sparta, IL
  • NPI 1114984226

  IL

  Medicare reassignment NPD
• St. Mary'S Hospital, Centralia, Illinois

  • Emergency Medicine Physician
  • Centralia, IL
  • NPI 1770687196

  IL

  Medicare reassignment NPD
• Memorial Hospital

  • Institutional Pharmacy
  • Chester, IL
  • NPI 1023603289
  Care Compare group NPD
• Aim Anesthesia LLC

  • Anesthesiology Physician
  • Bridgetown, MO
  • NPI 1245685601

  MO

  Medicare reassignment
• Memorial Hospital

  • Rural Health Clinic/Center
  • Steeleville, IL
  • NPI 1225429566
  Care Compare group
• Memorial Hospital

  • Rural Health Clinic/Center
  • Chester, IL
  • NPI 1629469002
  Care Compare group
• St. Mary'S Hospital, Centralia, Illinois

  • Anesthesiology Physician
  • Centralia, IL
  • NPI 1477097871
  NPD
• St. Mary'S Hospital, Centralia, Illinois

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Centralia, IL
  • NPI 1710105192
  NPD
• Southern Orthopedic Associates SC

  • Orthopaedic Surgery Physician
  • Herrin, IL
  • NPI 1396792412
  NPD (past)
• Lourdes Ambulatory Surgery Center, LLC

  • Certified Registered Nurse Anesthetist
  • Paducah, KY
  • NPI 1275770943

  Nurse Anesthetist, Certified Registered

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Memorial Hospital

  • Critical Access Hospital
  • Chester, IL
  • NPI 1851390132

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780012800000",
    "number": "1164569729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10117 PINE CREST RD",
            "city": "RED BUD",
            "state": "IL",
            "postal_code": "622784458",
            "telephone_number": "270-898-1922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10117 PINE CREST RD",
            "city": "RED BUD",
            "state": "IL",
            "postal_code": "622784458",
            "telephone_number": "618-282-2872"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "818 E Broadway St",
            "address_purpose": "LOCATION",
            "city": "Sparta",
            "state": "IL",
            "postal_code": "622861820",
            "country_code": "US",
            "telephone_number": "618-443-2177",
            "fax_number": "618-443-1380",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JEFFRY",
        "middle_name": "LYNES",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-31",
        "last_updated": "2026-05-29",
        "certification_date": "2026-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KY",
            "license": "3002489",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MO",
            "license": "124294",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "209-000383",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7424890700",
            "state": "KY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ehr-direct@spartahospital.hin.us",
            "affiliation": "N",
            "address_1": "818 E Broadway St",
            "city": "Sparta",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622861820",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Gail Meyer
• Terri Milton
• Kellye Mounts, RN
• Christy Palm
• Perandoe Special Education District
• Caitlin Poston, M.S. CCC-SLP
• Rachel Gibson Inc.
• Aimee Kathleen Range, P.T.
• Red Bud Clinic Corp
• Red Bud Comm Unit School Dist 132

• All providers in Red Bud, IL
• Certified Registered Nurse Anesthetist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.