Jodi Peterson

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

1195 NW Wall St
Bend, OR 97703-1965

Phone

(541) 728-0062

NPI assigned

Apr 10, 2015

Last updated

Dec 5, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Central Oregon Family Therapy

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Redmond, OR
  • NPI 1356930424
  NPD Authorized official

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

{
    "created_epoch": "1428624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480896000000",
    "number": "1659767184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3995 MARCOLA RD",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974777948",
            "telephone_number": "541-726-1465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1195 NW WALL ST",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977031965",
            "telephone_number": "541-728-0062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JODI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-10",
        "last_updated": "2016-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peterson Performance Products Inc (Peterson's Orthotic Lab)
• Peterson Performance Products, Inc. (Foot Fitness)
• Elizabeth Anne Peterson
• Jake Allen Peterson, DDS, MD
• Jessica Peterson
• Johanna Rae Peterson, PA-C
• Lindsey Peterson, PA-C
• Sarah Elizabeth Peterson, LCSW
• Theresa Ann Peterson
• Carol J Petherbridge, ND

• Mental Health Counselor in Bend, OR
• Providers in Bend, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2016; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.