Jay William Peterson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

JP004176 Issued in MI

Practice address

2305 Genoa Business Park Dr
Suite 170
Brighton, MI 48114-7367

Phone

(810) 299-8550

Fax

(810) 844-0837

NPI assigned

Mar 23, 2006

Last updated

Jun 7, 2011By the provider in NPPES

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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Advanced Orthopedic Specialists PC

  • Non-Pharmacy Dispensing Site
  • Brighton, MI
  • NPI 1053625467
  NPD (past)

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

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1307404800000",
    "number": "1558320853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2305 GENOA BUSINESS PARK DR",
            "address_2": "SUITE 170",
            "city": "BRIGHTON",
            "state": "MI",
            "postal_code": "481147367",
            "telephone_number": "810-299-8550",
            "fax_number": "810-844-0837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2305 GENOA BUSINESS PARK DR",
            "address_2": "SUITE 170",
            "city": "BRIGHTON",
            "state": "MI",
            "postal_code": "481147367",
            "telephone_number": "810-299-8550",
            "fax_number": "810-844-0837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JAY",
        "middle_name": "WILLIAM",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-23",
        "last_updated": "2011-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "JP004176",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "0D71023",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MI LICENSE #",
            "identifier": "JP004176",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ignazio Dominic Perna, DPM
• Perspectives Therapy Services LLC
• Peter M Lisiecki PHD PC Inc
• Michael Joseph Peters, PA-C
• Brian Jon Petersburg, D.D.S.
• Physiotherapy Associates Inc
• Taylor Bell Picano, CCC-SLP
• Tanuka Datta Piech, MD
• Brita Pietila, LPN
• Pillar Medical Group Inc.

• Physician Assistant in Brighton, MI
• Providers in Brighton, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.