Individual provider Active NPI

Pamela Teresa Peterson, NP

  • Acute Care Nurse Practitioner
  • Jackson, MI
National Provider Identifier
1255371530
Registry record updated Sep 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
4704194081 Issued in MI
Practice address
300 W Washington Ave
Suite 300
Jackson, MI 49201-2180
Phone
(517) 841-1305
Fax
(517) 841-1306
NPI assigned
Jun 7, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 4704194081 MI
Acute Care Nurse Practitioner 363LA2100X 4704194081 MI Primary

Addresses

Primary practice location

300 W Washington Ave
Suite 300
Jackson, MI 49201-2180

Mailing address

PO Box 670884
Detroit, MI 48267-0884
Phone (800) 999-5829

Other identifiers 2

IdentifierTypeStateIssuer
1255371530MedicaidMI
P00252787OtherMIRR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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

Enrollment IDStateProvider typePAC IDDetails
I20050730000027 MI Practitioner - Nurse Practitioner 0840228953 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

205 N E Ave
Henry Ford Allegiance Health
Jackson, MI 49201-1753
Phone (517) 205-4800

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Hospitalist Medicine Physicians of Michigan, PLLC CurrentSince Jun 29, 2019 Accepting new patients
W.a. Foote Memorial Hospital, Inc Nurse Practitioner CurrentSince Apr 5, 2018 Accepting new patients
Hospitalist Medicine Physicians of Michigan PLLC CurrentSince Jun 29, 2019 Accepting new patients
Sound Inpatient Physicians - Michigan, PLLC CurrentSince Jun 22, 2019 Accepting new patients
Sound Inpatient Physicians-Michigan, PLLC Nurse Practitioner Current Accepting new patients
Degara App, PLLC Nurse Practitioner CurrentSince Sep 8, 2018 Accepting new patients
Sound Inpatient Physicians-Michigan PLLC CurrentSince Jun 22, 2019 Accepting new patients
MVC CT Past Accepting new patients
Wa Foote Memorial Hospital, Inc Past Accepting new patients
Cogent Healthcare of Michigan PC Nurse Practitioner Past Accepting new patients
MVC Az Past Accepting new patients
Anchor Health Centers PA Past Accepting new patients

Locations

818 Riverside Ave
Adrian, MI 49221
Phone (517) 263-0711

1721 S Stephenson Ave
Iron Mountain, MI 49801
Phone (906) 776-5415

205 N East Ave
Jackson, MI 49201
Phone (517) 788-4730

300 W Washington Ave
Ste 300
Jackson, MI 49201
Phone (517) 205-1305

401 W Greenlawn Ave
Lansing, MI 48910
Phone (517) 334-2286

1 Atkinson Dr
Ludington, MI 49431
Phone (231) 843-2591

1465 E Parkdale Ave
Manistee, MI 49660
Phone (231) 398-1000

580 W College Ave
Marquette, MI 49855
Phone (906) 225-3131

50 N Perry St
Pontiac, MI 48342
Phone (248) 338-5300

7845 Spring Arbor Rd
Spring Arbor, MI 49283
Phone (517) 205-2580

200 Hemlock St
Tawas City, MI 48763
Phone (989) 362-0153

500 E Pottawatamie St
Tecumseh, MI 49286
Phone (517) 266-0525

1105 Sixth St
Traverse City, MI 49684
Phone (231) 922-9000

Interoperability endpoints

  • Direct secure messaging: ppeterson456453@direct.hfhs.org

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757289600000",
    "number": "1255371530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 670884",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482670884",
            "telephone_number": "800-999-5829",
            "fax_number": "248-641-4840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 W WASHINGTON AVE",
            "address_2": "SUITE 300",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492012180",
            "telephone_number": "517-841-1305",
            "fax_number": "517-841-1306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "PAMELA",
        "middle_name": "TERESA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-07",
        "last_updated": "2025-09-08",
        "certification_date": "2025-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704194081",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MI",
            "license": "4704194081",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1255371530",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00252787",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MI

Sources for this page

Verify at the official NPI Registry.