Jedidiah Allen Petersen, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-1110 Issued in ID

Practice address

6 13TH Ave E
Polson, MT 59860-5315

Phone

(406) 883-5680

Fax

(406) 883-8960

NPI assigned

Oct 30, 2013

Sex

Male

Sole proprietor

No

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

Enrolled in MT

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

Specialty

Physician Assistant

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Providence St Joseph Medical CenterGroup PAC ID 0446230247, 52 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Partners in Home Care Inc Home health agency, Missoula, MT, CCN 277032
• Providence St Joseph Medical Center Hospital, Polson, MT, CCN 271343
• St. Patrick Hospital Hospital, Missoula, MT, CCN 270014
• St Luke Community Hospital Hospital, Ronan, MT, CCN 271325

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jpetersen554472@wm.providencedirect.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.

• Providence St Joseph Medical Center

  • Family Medicine Physician
  • Polson, MT
  • NPI 1669655528
  Medicare reassignment Care Compare group NPD
• Providence St Joseph Medical Center

  • Critical Access Hospital
  • Polson, MT
  • NPI 1821184888
  Medicare reassignment
• Credena Health LLC

  • Community/Retail Pharmacy
  • Polson, MT
  • NPI 1164809778
  NPD

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

• Partners in Home Care, Inc.

  • Home Health Agency
  • Missoula, MT
  • NPI 1629135447
  Care Compare affiliation
• Providence Health & Services Mt

  • General Acute Care Hospital
  • Missoula, MT
  • NPI 1023032588
  Care Compare affiliation
• Providence Health & Services Mt

  • Medical Oncology Physician
  • Missoula, MT
  • NPI 1326483587

  Hospital

  Care Compare affiliation
• Providence Health & Services Mt

  • Anatomic Pathology & Clinical Pathology Physician
  • Missoula, MT
  • NPI 1366185928

  Hospital

  Care Compare affiliation
• Providence Health & Services Mt

  • Psychiatric Hospital Unit
  • Missoula, MT
  • NPI 1619058302
  Care Compare affiliation
• Providence St Joseph Medical Center

  • Critical Access Hospital
  • Polson, MT
  • NPI 1821184888
  Care Compare affiliation
• St Lukes Community Hospital

  • Critical Access Hospital
  • Ronan, MT
  • NPI 1336213446
  Care Compare affiliation

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

{
    "created_epoch": "1383091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1449532800000",
    "number": "1366870206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 262",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990190262",
            "telephone_number": "208-232-7862",
            "fax_number": "208-232-7869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 13TH AVE E",
            "city": "POLSON",
            "state": "MT",
            "postal_code": "598605315",
            "telephone_number": "406-883-5680",
            "fax_number": "406-883-8960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "JEDIDIAH",
        "middle_name": "ALLEN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-10-30",
        "last_updated": "2015-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-1110",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeremy Page
• Paladin Enterprises, Inc.
• Amy Gail Parsons, MA., CCC-SLP
• Shania Monique Patacsil, SWLC
• Leslie Anne Patterson, PTA
• Susan M Peterson, R.N.
• Lacey J Phelan, DPT
• Richard Pierre, CPHT
• Malgorzata Podraza, O.D.
• Polson Ambulance, Inc.

• Physician Assistant in Polson, MT
• Providers in Polson, MT by specialty
• Physician Assistant in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2015; 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.