Active NPI
Jared M. Petersen, DO
- Family Medicine Physician
- Kennewick, WA
National Provider Identifier
1285327841
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- DO.OP.70107140
- Practice address
- 3900 S Zintel Way Ste 110
Kennewick, WA 99337-5044 - Phone
- (509) 942-3125
- Fax
- (509) 585-8173
- NPI assigned
- May 31, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | DO.OP.70107140 | WA | Primary |
Addresses
Primary practice location
3900 S Zintel Way Ste 110
Kennewick, WA 99337-5044
Mailing address
550 Gage Blvd Ste 101
Richland, WA 99352-9532
Phone (509) 946-4611
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230731002585 | WA | Order and Referring Only - Family Practice | 6204297765 |
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- University of Pikeville, Kentucky College of Osteopathic Med, 2023
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
550 Gage Blvd
Suite 101
Richland, WA 99352-9528
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OL61438195 | WA | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1685491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1782777600000",
"number": "1285327841",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "550 GAGE BLVD STE 101",
"city": "RICHLAND",
"state": "WA",
"postal_code": "993529532",
"telephone_number": "509-946-4611",
"fax_number": "509-627-2983"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3900 S ZINTEL WAY STE 110",
"city": "KENNEWICK",
"state": "WA",
"postal_code": "993375044",
"telephone_number": "509-942-3125",
"fax_number": "509-585-8173"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSEN",
"first_name": "JARED",
"middle_name": "M.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-05-31",
"last_updated": "2026-06-30",
"certification_date": "2026-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WA",
"license": "DO.OP.70107140",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kennewick, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2026; 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.