Jacob Duane Peters, PA-C

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

PA185067 Issued in OR

Practice address

2725 SW Cedar Hills Blvd Ste 2a
Beaverton, OR 97005-1344

Phone

(503) 352-6000

Fax

(503) 434-8597

NPI assigned

Dec 1, 2017

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 OR

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

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Virginia Garcia Memorial Health CenterGroup PAC ID 7113823881, 87 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence St Vincent Medical Center Hospital, Portland, OR, CCN 380004

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Interoperability endpoints

• Direct secure messaging: jpeters201810@direct.ochin.org

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.

• Virginia Garcia Memorial Health Center

  • Federally Qualified Health Center (FQHC)
  • Cornelius, OR
  • NPI 1679528012
  Medicare reassignment Care Compare group NPD (past)

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

• Providence Health & Services - Oregon

  dba Providence St Vincent Medical Center

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1114015971
  Care Compare affiliation

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

{
    "created_epoch": "1512086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549843200000",
    "number": "1164936985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6149",
            "city": "ALOHA",
            "state": "OR",
            "postal_code": "970070149",
            "telephone_number": "503-359-8501",
            "fax_number": "503-434-8597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2725 SW CEDAR HILLS BLVD STE 2A",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970051344",
            "telephone_number": "503-352-6000",
            "fax_number": "503-434-8597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERS",
        "first_name": "JACOB",
        "middle_name": "DUANE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-12-01",
        "last_updated": "2019-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "PA185067",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina Lee Perry, MOT
• Craig Perry, CSWA
• Lisa Perry
• Rebecca A Perry
• Andrew Persoon, LMT
• Kristina Petersen, RDH
• Desmond Kirk Peterson, N.D.
• Glenda A Peterson, PMHN
• Jennie Michelle Peterson, PMHNP-BC
• Leslie Lucinda Peterson, RDH, OMT

• Family Medicine Physician in Beaverton, OR
• Providers in Beaverton, OR by specialty
• Family Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2019; 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.