Jeffrey Robert Petra, PH.D.

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

Practice address

1800 Cooper Point Rd SW Ste 17
Olympia, WA 98502-1179

Phone

(360) 754-4662

Fax

(360) 352-3289

NPI assigned

Oct 26, 2006

Sex

Male

Sole proprietor

Yes

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 WA

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 Psychologist

Education

Other, 2000

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1487739603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11009",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985081009",
            "telephone_number": "360-352-2037",
            "fax_number": "360-352-0637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 COOPER POINT RD SW STE 17",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985021179",
            "telephone_number": "360-754-4662",
            "fax_number": "360-352-3289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRA",
        "first_name": "JEFFREY",
        "middle_name": "ROBERT",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bonnie Louise Peterson
• John E Peterson, OD
• Malgorzata Dymerska Peterson, MD
• Rebecca J Peterson, A.R.N.P.
• William W. Peterson, M.D.
• Brittany Brooke Petrie, DPT
• Petrina Gavrilis FNP-BC Arnp Family Health Care Services, LLC
• Megan Nicole Pettibone, PHARMD
• George Petzinger, M.D.
• Steve F Pfandl, MPT

• Clinical Child & Adolescent Psychologist in Olympia, WA
• Providers in Olympia, WA by specialty
• Clinical Child & Adolescent Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.