Individual provider Active NPI

Jane K Peterson, MD

  • Family Medicine Physician
  • W. St. Paul, MN
National Provider Identifier
1598872806
Registry record updated Apr 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
48728 Issued in MN
Practice address
153 Cesar Chavez St
W. St. Paul, MN 55107-2226
Phone
(651) 222-1816
Fax
(651) 222-1305
NPI assigned
Aug 23, 2006
Last updated
Apr 22, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 48728 MN Primary

Addresses

Primary practice location

153 Cesar Chavez St
W. St. Paul, MN 55107-2226

Mailing address

153 Cesar Chavez St
W. St. Paul, MN 55107-2226
Phone (651) 222-1816

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061220000237 MN Practitioner - Family Practice 9436158466 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Wisconsin School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

153 Cesar Chavez St
Saint Paul, MN 55107-2226
Phone (651) 602-7500

895 7TH St E
Saint Paul, MN 55106-3871
Phone (651) 602-7500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
48728MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
West Side Community Health Services, Inc. CurrentSince Mar 1, 2008 Accepting new patients
West Side Community Health Services, Inc. CurrentSince Mar 1, 2008 Accepting new patients
West Side Community Health Services, Inc. Current Accepting new patients

Locations

1544 Timberlake Rd
Saint Paul, MN 55117
Phone (651) 558-2191

45 10th St W
Saint Paul, MN 55102
Phone (651) 232-3000

895 7th St E
Saint Paul, MN 55106
Phone (651) 793-2250

153 Cesar Chavez St
West Saint Paul, MN 55107
Phone (651) 222-1816

Interoperability endpoints

  • Direct secure messaging: jpeterson733170@direct.ochin.org

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366588800000",
    "number": "1598872806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "153 CESAR CHAVEZ ST",
            "city": "W. ST. PAUL",
            "state": "MN",
            "postal_code": "551072226",
            "telephone_number": "651-222-1816",
            "fax_number": "651-222-1305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "153 CESAR CHAVEZ ST",
            "city": "W. ST. PAUL",
            "state": "MN",
            "postal_code": "551072226",
            "telephone_number": "651-222-1816",
            "fax_number": "651-222-1305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JANE",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-23",
        "last_updated": "2013-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "48728",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in W. St. Paul, MN

Sources for this page

Verify at the official NPI Registry.