NPIMap

Individual provider Active NPI

Jonathan B Peterson, MD

  • Family Medicine Physician
  • Westminster, CO
National Provider Identifier
1659450005
Registry record updated Feb 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
41487 Issued in CO
Practice address
500 W 144TH Ave Ste 140
Westminster, CO 80023-9326
Phone
(303) 430-2640
Fax
(303) 430-2625
NPI assigned
Nov 6, 2006
Last updated
Feb 9, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2023

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 41487 CO Primary

Addresses

Primary practice location

500 W 144TH Ave Ste 140
Westminster, CO 80023-9326

Mailing address

500 W 144TH Ave Ste 140
Westminster, CO 80023-9326
Phone (303) 430-2640

Other practice location 1

11700 W 2nd Pl Ste 450
Lakewood, CO 80228-1719
Phone (303) 825-1234

Other identifiers 2

IdentifierTypeStateIssuer
91120551MedicaidCO
9000178662MedicaidCO

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191203001267 CO Practitioner - Geriatric Medicine 4688979586 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Geriatric Medicine
Education
Northwestern University Feinberg Medical School, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

11700 W 2ND PL
Lakewood, CO 80228-1719
Phone (303) 825-1234

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
41487COMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Geriatric Medicine Associates, PC CurrentSince Jan 2, 2020 Accepting new patients
Geriatric Medicine Associates, PC CurrentSince Jan 2, 2020 Accepting new patients

Locations

11700 W 2nd Pl
Ste 4450
Lakewood, CO 80228
Phone (303) 825-1234

11700 W 2nd Pl
Ste 450
Lakewood, CO 80228
Phone (303) 825-1234

500 W 144th Ave
Ste 140
Westminster, CO 80023
Phone (303) 430-2640

Organizations & group practices 2

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.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675900800000",
    "number": "1659450005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W 144TH AVE STE 140",
            "city": "WESTMINSTER",
            "state": "CO",
            "postal_code": "800239326",
            "telephone_number": "303-430-2640",
            "fax_number": "303-430-2625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W 144TH AVE STE 140",
            "city": "WESTMINSTER",
            "state": "CO",
            "postal_code": "800239326",
            "telephone_number": "303-430-2640",
            "fax_number": "303-430-2625"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11700 W 2nd Pl Ste 450",
            "address_purpose": "LOCATION",
            "city": "Lakewood",
            "state": "CO",
            "postal_code": "802281719",
            "country_code": "US",
            "telephone_number": "303-825-1234",
            "fax_number": "720-321-8121",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JONATHAN",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-06",
        "last_updated": "2023-02-09",
        "certification_date": "2023-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "41487",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "91120551",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000178662",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Westminster, CO

Sources for this page

Verify at the official NPI Registry.