Jeffery Lee Peterson, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

1067 Issued in SD

Practice address

701 W Broad Ave
Flandreau, SD 57028-1529

Phone

(605) 997-2642

Fax

(605) 997-9940

NPI assigned

Jan 12, 2007

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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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 and National Provider Directory roles.

• Flandreau Santee Sioux Tribe

  • Pharmacy
  • Flandreau, SD
  • NPI 1558387076
  NPD (past)

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

{
    "created_epoch": "1168560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1639229255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1027 LAWRENCE CIR",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563772081",
            "telephone_number": "605-997-2642",
            "fax_number": "605-997-9940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 W BROAD AVE",
            "city": "FLANDREAU",
            "state": "SD",
            "postal_code": "570281529",
            "telephone_number": "605-997-2642",
            "fax_number": "605-997-9940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JEFFERY",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SD",
            "license": "1067",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5546010",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katherine E Krystosek, MS, ATC
• Leslie J. Heinemann, DDS, PC
• Amanda McMillan, CNP
• Jeanie Alyson Nold, R.PH.
• Megan Petersen, ATC
• Mariah Peterson, CNP
• Scott Peterson, MD
• James Edson Powell, M.D.
• Prairie Phoenix PLLC
• Lacey M Richard I, LPC-MH, CAC QMHP

• All providers in Flandreau, SD
• Family Medicine Physician in South Dakota

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.