Jed Russell Peterson, M.D.

Primary specialty

Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X

License

157199 Issued in OR

Practice address

10123 SE Market St
Department of Radiology
Portland, OR 97216-2532

Phone

(503) 251-6137

Fax

(503) 261-6058

NPI assigned

May 4, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OR

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

Specialty

Diagnostic Radiology

Education

Albany Medical College of Union University, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Diagnostic Radiologists PCGroup PAC ID 4183510902, 16 clinicians

Providence St Joseph Medical CenterGroup PAC ID 0446230247, shared by 5 NPIs, 52 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Adventist Health Portland Hospital, Portland, OR, CCN 380060
• Ohsu Hospital and Clinics Hospital, Portland, OR, CCN 380009
• Mid-Columbia Medical Center Hospital, The Dalles, OR, CCN 380001

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• HI PPO
• devoted network organization-c89d4c14-e90f-4cf7-83f9-456527a52335

Interoperability endpoints

• Direct secure messaging: jpeterson113675@direct.ohsu.edu

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.

• Diagnostic Radiologists PC

  • Diagnostic Radiology Physician
  • Portland, OR
  • NPI 1053368563
  Medicare reassignment Care Compare group Authorized official
• Portland Adventist Medical Center

  • Family Medicine Physician
  • Portland, OR
  • NPI 1750091021
  Medicare reassignment NPD
• Diagnostic Radiologists, PC

  • Diagnostic Radiology Physician
  • Portland, OR
  • NPI 1780702993
  NPD Authorized official
• Portland Adventist Medical Center

  • Anesthesiology Physician
  • Portland, OR
  • NPI 1437925310
  NPD
• Portland Adventist Medical Center

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1801887658
  NPD (past)

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

• Mid-Columbia Medical Center

  • Critical Access Hospital Clinic/Center
  • The Dalles, OR
  • NPI 1306842752
  Care Compare affiliation
• Oregon Health & Science University

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1609824010
  Care Compare affiliation
• Portland Adventist Medical Center

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1801887658
  Care Compare affiliation

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

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350259200000",
    "number": "1164634770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10123 SE MARKET ST",
            "address_2": "DEPARTMENT OF RADIOLOGY",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972162532",
            "telephone_number": "503-251-6137",
            "fax_number": "503-261-6058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10123 SE MARKET ST",
            "address_2": "DEPARTMENT OF RADIOLOGY",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972162532",
            "telephone_number": "503-251-6137",
            "fax_number": "503-261-6058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JED",
        "middle_name": "RUSSELL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-04",
        "last_updated": "2012-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WA",
            "license": "MD.60212410",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "WA",
            "license": "MD.60212410",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OR",
            "license": "157199",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "OR",
            "license": "157199",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OREGON MEDICAL BOARD",
            "identifier": "157199",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE NUMBER",
            "identifier": "MD60212410",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emily Erin Peterson, DPT
• Georgia K Peterson, L.M.T
• Heather Peterson, LCSW
• Heidi Belinda Peterson, N.D.
• Jaime Wildman Peterson, M.D.
• Jenny Lynn Peterson, RN
• Jessica Peterson
• Julie M. Peterson, PMHNP
• Kathryn Peterson
• Katlyn Rene Peterson, OD

• Vascular & Interventional Radiology Physician in Portland, OR
• Providers in Portland, OR by specialty
• Vascular & Interventional Radiology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2012; 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.
• 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.