Michelle Annmarie Jackson Petersen, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

F348339-01 Issued in NY

Practice address

2322 30TH Rd Ste 1a
Astoria, NY 11102-3238

Phone

(667) 326-9198

NPI assigned

Dec 20, 2022

Sex

Female

Sole proprietor

Yes

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 NY

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

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Samuel Akuoku Physician PLLCGroup PAC ID 2860613049, 4 clinicians

Laurelton Medical Physicians PLLCGroup PAC ID 9537646179, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678

Interoperability endpoints

• Direct secure messaging: mjacksonpetersen271214@direct.medisys.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.

• Laurelton Medical Physicians PLLC

  • Clinic/Center
  • Laurelton, NY
  • NPI 1902216229
  Medicare reassignment Care Compare group NPD
• Jamaica Hospital

  • Emergency Medical Services (Emergency Medicine) Physician
  • Jamaica, NY
  • NPI 1477505220
  Medicare reassignment NPD
• Jamaica Hospital

  • Skilled Nursing Facility
  • Jamaica, NY
  • NPI 1750516795
  NPD
• Samuel Akuoku Physician PC

  • Medical Specialty Clinic/Center
  • Laurelton, NY
  • NPI 1013070366
  NPD (past)

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

{
    "created_epoch": "1671494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730246400000",
    "number": "1205548443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21917 130TH DR",
            "city": "SPRINGFIELD GARDENS",
            "state": "NY",
            "postal_code": "114131220",
            "telephone_number": "718-276-2651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2322 30TH RD STE 1A",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111023238",
            "telephone_number": "667-326-9198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON PETERSEN",
        "first_name": "MICHELLE",
        "middle_name": "ANNMARIE",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-12-20",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F348339-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph Isaakidis, RPH
• Joshua Ishal, DDS
• Dina Issa
• Monica Iverson, APRN, WHNP-BC
• Rupa Lakshmi Iyengar-Kapuganti, MD
• Latayvia Sheris Jackson
• Kimberly A Jackus, MD
• Arthur Jacobs, SLP
• Asad Jafary
• Czarinabelle Jaffery

• Family Nurse Practitioner in Astoria, NY
• Providers in Astoria, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2024; 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.