NPIMap

Individual provider Active NPI

Johanna Rae Peterson, PA-C

  • Medical Physician Assistant
  • Bend, OR
National Provider Identifier
1396934238
Registry record updated Sep 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA01280 Issued in OR
Practice address
2200 NE Neff Rd Ste 302
Bend, OR 97701-4279
Phone
(541) 706-4220
NPI assigned
Oct 16, 2007
Last updated
Sep 17, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA01280 OR Primary

Addresses

Primary practice location

2200 NE Neff Rd Ste 302
Bend, OR 97701-4279

Mailing address

PO Box 1188
Corvallis, OR 97339-1188

Other practice location 1

400 Hickory St NW Ste 303
Albany, OR 97321-1700
Phone (541) 812-5275

Other names 1

  • Johanna Rae Godell Former name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jpeterson192172@samhealth.direct-ci.com
Direct Messaging Address jpeterson160764@secure.stcharleshealthcare.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080102000463 OR Practitioner - Physician Assistant 1951481092 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Oregon Health Sciences University School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Charles Health System IncGroup PAC ID 8729111513, 379 clinicians

Practice addresses (Care Compare)

1315 NW 4TH St
Redmond, OR 97756-1328
Phone (541) 706-4200

211 NW Larch Ave
Family Care
Redmond, OR 97756-1357
Phone (541) 548-2164

2500 NE Neff Rd
Bend, OR 97701-6015

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA01280ORMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St. Charles Health System, Inc. CurrentSince Oct 3, 2022 Accepting new patients
St. Charles Health System, Inc. CurrentSince Oct 3, 2022 Accepting new patients
Advanced Surgical Care, LLC Past Accepting new patients
Cardiovascular Consultants of the Cascades LLP Past Accepting new patients
St. Charles Health System, Inc. Past Accepting new patients

Locations

29358 Network Pl
Chicago, IL 60673

2200 NE Neff Rd
Ste 302
Bend, OR 97701
Phone (541) 706-4220

61250 SE Coombs Pl
Bend, OR 97702
Phone (541) 706-5930

211 NW Larch Ave
Redmond, OR 97756
Phone (541) 548-2164

Interoperability endpoints

  • Direct secure messaging: jpeterson160764@secure.stcharleshealthcare.org

Organizations & group practices 7

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.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1192492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726531200000",
    "number": "1396934238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1188",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973391188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 NE NEFF RD STE 302",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977014279",
            "telephone_number": "541-706-4220"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 Hickory St NW Ste 303",
            "address_purpose": "LOCATION",
            "city": "Albany",
            "state": "OR",
            "postal_code": "973211700",
            "country_code": "US",
            "telephone_number": "541-812-5275",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JOHANNA",
        "middle_name": "RAE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-16",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OR",
            "license": "PA01280",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jpeterson192172@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "400 Hickory St NW Ste 303",
            "city": "Albany",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973211700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jpeterson160764@secure.stcharleshealthcare.org",
            "affiliation": "N",
            "address_1": "2200 NE Neff Rd Ste 302",
            "city": "Bend",
            "state": "OR",
            "country_code": "US",
            "postal_code": "977014279",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JOHANNA",
            "last_name": "GODELL",
            "middle_name": "RAE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Bend, OR

Sources for this page

Verify at the official NPI Registry.