Jacob Edward Peterson, MD, MBA

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

License

76208 Issued in CT

Practice address

79 Wawecus St Ste 103
Norwich, CT 06360-2173

Phone

(860) 886-1862

Fax

(860) 886-2046

NPI assigned

Mar 16, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 6

Addresses

Other names 1

• Dr. Jacob Edward Peterson Other name

Medicare fee-for-service enrollment

Enrolled in VA, CT2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Internal MedicineAlso: Pulmonary Disease

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pulmonary Physicians of Norwich PCGroup PAC ID 5092601955, 10 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Business Administration, Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jpeterson615616@direct.ynhh.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.

• Pulmonary Physicians of Norwich PC

  • Pulmonary Disease Physician
  • Norwich, CT
  • NPI 1457426934

  Internal Medicine

  Medicare reassignment Care Compare group NPD (past)
• Sentara Medical Group

  • Family Medicine Physician
  • Norfolk, VA
  • NPI 1265485270

  Internal Medicine

  Medicare reassignment NPD

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

{
    "created_epoch": "1458086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785801600000",
    "number": "1295196384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "79 WAWECUS ST STE 103",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063602173",
            "telephone_number": "860-886-1862",
            "fax_number": "860-886-2046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "79 WAWECUS ST STE 103",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063602173",
            "telephone_number": "860-886-1862",
            "fax_number": "860-886-2046"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 Gresham Dr Fl 5",
            "address_purpose": "LOCATION",
            "city": "Norfolk",
            "state": "VA",
            "postal_code": "235071904",
            "country_code": "US",
            "telephone_number": "757-388-3198",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "20 York St",
            "address_purpose": "LOCATION",
            "city": "New Haven",
            "state": "CT",
            "postal_code": "065103220",
            "country_code": "US",
            "telephone_number": "203-688-4242",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JACOB",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "MD, MBA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-16",
        "last_updated": "2026-08-04",
        "certification_date": "2026-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "VA",
            "license": "0101263068",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "VA",
            "license": "0101263068",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "76208",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101263068",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "CT",
            "license": "76208",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACOB",
            "last_name": "PETERSON",
            "middle_name": "EDWARD",
            "prefix": "DR.",
            "credential": "MD, MBA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Carol Lee Pennell, RNC, IBCLC,CCE
• David Allen Percival, D.M.D.
• Kelsey Lynn Perez
• Amanda Marie Pernal
• Perspective Counseling Services LLC
• Jodi Sandra Peterson, LIC PROF COUNSELOR
• Michael William Petrides, M.S.(R), ABD, LPC
• Demetrios Petropoulos, DMD
• Sandra Fortier Philips, LCSW
• Colleen Ellen Phillips-White, L.C.S.W.

• Pulmonary Disease Physician in Norwich, CT
• Providers in Norwich, CT by specialty
• Pulmonary Disease Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 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.

Verify at the official NPI Registry.