Jon Fredrick Petersen, M.D.

Primary specialty

Occupational Medicine PhysicianTaxonomy code 2083X0100X

License

036129728 Issued in IL

Practice address

1750 E Lake Shore Dr
Decatur, IL 62521-3803

Phone

(217) 464-1440

Fax

(217) 464-1469

NPI assigned

Oct 3, 2005

Last updated

Oct 12, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Orthopaedic Center of Il

  • Orthopaedic Surgery Physician
  • Springfield, IL
  • NPI 1154300572
  NPD (past)
• Orthopaedic Center of Illinois

  • Durable Medical Equipment & Medical Supplies
  • Springfield, IL
  • NPI 1144372798
  NPD (past)
• Emcare Physician Providers, Inc.

  • Emergency Medicine Physician
  • Opp, AL
  • NPI 1356391353
  NPD (past)

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

{
    "created_epoch": "1128297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476230400000",
    "number": "1285621516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1750 E LAKE SHORE DR",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625213803",
            "telephone_number": "217-464-1440",
            "fax_number": "217-464-1469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 E LAKE SHORE DR",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625213803",
            "telephone_number": "217-464-1440",
            "fax_number": "217-464-1469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "JON",
        "middle_name": "FREDRICK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-03",
        "last_updated": "2016-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083X0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "IL",
            "license": "036129728",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036129728",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "250766",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kailey N Perry, COTA/L
• Laura Perry, L.M.T
• Personal Medical Supply, Inc.
• Leeann Petak, CRNA
• Tonya Sue Peters, SLP
• Julia Peterson
• Waymond Jay Pettit, M.D.
• Susan Kay Petty, SPEECH THERAPIST
• Cheryl Janene Peyton
• Jeffrey Pfeiffer, MD

• Occupational Medicine Physician in Decatur, IL
• Providers in Decatur, IL by specialty
• Occupational Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2016; 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.