Jodi A Pettersen, R.D.

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Practice address

783 Basque Way
Carson City, NV 89706-7981

Phone

(775) 720-3490

Fax

(775) 888-9510

NPI assigned

Jan 19, 2007

Sex

Female

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 NV

Enrollment records 1

Specialty

Registered Dietitian Or Nutrition Professional

Education

Other, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Great Basin Nutrition LLCGroup PAC ID 2365783115, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Great Basin Nutrition LLC

  • Registered Dietitian
  • Carson City, NV
  • NPI 1053883520

  Dietitian, Registered

  Medicare reassignment Care Compare group NPD Authorized official
• Silver State Nutrition LLP

  • Registered Dietitian
  • Carson City, NV
  • NPI 1003960550

  Dietitian, Registered

  NPD (past) Authorized official

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400457600000",
    "number": "1598818619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "783 BASQUE WAY",
            "city": "CARSON CITY",
            "state": "NV",
            "postal_code": "897067981",
            "telephone_number": "775-720-3490",
            "fax_number": "775-888-9510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "783 BASQUE WAY",
            "city": "CARSON CITY",
            "state": "NV",
            "postal_code": "897067981",
            "telephone_number": "775-720-3490",
            "fax_number": "775-888-9510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTERSEN",
        "first_name": "JODI",
        "middle_name": "A",
        "name_prefix": "Mrs.",
        "credential": "R.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-19",
        "last_updated": "2014-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer K Peters, APRN
• Christina Marie Petersen, MS
• Jennifer Lynne Peterson Highley, O.D.
• Kathleen Lavonne Peterson
• Kevin Mark Peterson, D.D.S.
• Cynthia Pham
• Crystal Phares, MD
• Sheree L Pharris, APN
• Kelina Phifer, APRN
• Mark Phillips

• Registered Dietitian in Carson City, NV
• Providers in Carson City, NV by specialty
• Registered Dietitian in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.