James Jerry Peterson III, BA.

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Practice address

2138 Blackwolf Run LN
Raleigh, NC 27604-5411

Phone

(916) 627-5859

NPI assigned

Aug 16, 2017

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Arts

Practice roles

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.

• Jspetersonyouthllc

  • Community/Behavioral Health Agency
  • Raleigh, NC
  • NPI 1568249001
  NPD Authorized official
• Total Education Solutions

  • Early Intervention Provider Agency
  • Rancho Cordova, CA
  • NPI 1841586757
  NPD (past)

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

{
    "created_epoch": "1502841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694995200000",
    "number": "1265958748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2138 BLACKWOLF RUN LN",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276045411",
            "telephone_number": "916-627-5859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2138 BLACKWOLF RUN LN",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276045411",
            "telephone_number": "916-627-5859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JAMES",
        "middle_name": "JERRY",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "BA.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-08-16",
        "last_updated": "2023-09-18",
        "certification_date": "2023-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maureen Petersen, M.D.
• Allura Peterson
• Bobbie Jo Peterson, NP
• Carrie Jo Peterson
• Jada Peterson
• James Wilson Peterson, M.D.
• Kelcey Peterson
• Kirk Darrel Peterson, M.D.
• Melissa Jo Peterson, NP-BC
• Seth Peterson

• Community/Behavioral Health Agency in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Community/Behavioral Health Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.