Jennifer Lynn Peterson

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

15296 Issued in MN

Practice address

301 Highway 65 S
Mora, MN 55051-1899

Phone

(320) 225-3579

Fax

(320) 225-3533

NPI assigned

Nov 15, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Family Based Therapy AssociatesGroup PAC ID 2264432681, 12 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Welia Health Hospital, Mora, MN, CCN 241367

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jpeterson162379@excellian.direct.allina.com

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.

• Family Based Therapy Associates

  • Mental Health Counselor
  • Coon Rapids, MN
  • NPI 1194762005

  MN

  Medicare reassignment Care Compare group NPD
• Welia Health

  • Critical Access Hospital
  • Mora, MN
  • NPI 1528031390

  MN

  Medicare reassignment NPD
• Welia Health

  • Critical Access Hospital Clinic/Center
  • Mora, MN
  • NPI 1972811362
  NPD
• Family Based Therapy Associates

  • Community/Behavioral Health Agency
  • Chisago City, MN
  • NPI 1891100293
  NPD (past)

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

• Welia Health

  • Critical Access Hospital
  • Mora, MN
  • NPI 1528031390

  Hospital

  Care Compare affiliation
• Welia Health

  • Critical Access Hospital Clinic/Center
  • Mora, MN
  • NPI 1972811362

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1573776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605052800000",
    "number": "1487299293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 HIGHWAY 65 S",
            "city": "MORA",
            "state": "MN",
            "postal_code": "550511899",
            "telephone_number": "320-225-3579",
            "fax_number": "320-225-3533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 HIGHWAY 65 S",
            "city": "MORA",
            "state": "MN",
            "postal_code": "550511899",
            "telephone_number": "320-225-3579",
            "fax_number": "320-225-3533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JENNIFER",
        "middle_name": "LYNN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-15",
        "last_updated": "2020-11-11",
        "certification_date": "2020-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "15296",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jpeterson162379@excellian.direct.allina.com",
            "affiliation": "Y",
            "affiliationName": "Welia Health",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "301 Highway 65 S",
            "city": "Mora",
            "state": "MN",
            "country_code": "US",
            "postal_code": "550511899",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Matthew Craig Patterson, M.D.
• Dustin Scott Paulson, CRNA
• Spencer L Pearson, PA-C
• Austin Michael Peterson, OD
• Cassie Peterson, MS, LMFT
• Shane Peterson
• Susan R Peterson
• Playful Healing, LLC
• Natalie Ann Radich
• Jeremiah Scott Randall, PMHNP-BC

• All providers in Mora, MN
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2020; 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.