NPIMap

Individual provider Active NPI

Jon T Peterson, DO

  • Family Medicine Physician
  • Anacortes, WA
National Provider Identifier
1669553723
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OP00001517 Issued in WA
Practice address
1213 24TH St Ste 100
Anacortes, WA 98221-2595
Phone
(360) 293-3101
NPI assigned
Oct 17, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 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 OP00001517 WA Primary

Addresses

Primary practice location

1213 24TH St Ste 100
Anacortes, WA 98221-2595

Mailing address

4804 Sunset Beach Drive NW
Olympia, WA 98502
Phone (360) 867-0595

Other practice location 1

2960-A Limited Lane NW
Olympia, WA 98502
Phone (360) 709-9500

Other identifiers 13

IdentifierTypeStateIssuer
50D1031645OtherCLIA
A1825OtherPREMERA LIFEWISE
O186018OtherL & I
2007PEOtherBLUESHIELD FEDERAL
3568326OtherAETNA HMO
A1820OtherPREMERA BLUE CROSS
OP00001517OtherWA STATE LICENSE
5617199OtherAETNA NON HMO
8192247OtherDSHS
A1820OtherPREMERA HEALTH
A1820OtherPREMERA DIMENSIONS
2007PEOtherREGENCE BLUESHIELD
601371600OtherUS DEPT OF LABOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20040712000279 WA Practitioner - Family Practice 0244218741 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Franciscan Medical GroupGroup PAC ID 0547173866, 1,400 clinicians
Select Outpatient Services IncGroup PAC ID 4082868815, 750 clinicians
Select Rehabilitation, LLCGroup PAC ID 9032020490, 1,935 clinicians

Practice addresses (Care Compare)

1211 24TH St
Anacortes, WA 98221-2562
Phone (360) 299-1350

1812 S J St
Suite 120
Tacoma, WA 98405-4965
Phone (253) 428-2200

2600 Compass Rd
Glenview, IL 60026-8001

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OP00001517WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Public Hospital District No 1 of Mason County Family Medicine CurrentSince Jun 15, 2016 Accepting new patients
Franciscan Medical Group Current Accepting new patients
Public Hospital District No 2 Skagit County Washington CurrentSince Nov 1, 2019 Accepting new patients
Public Hospital District No 1 of Mason County Wa CurrentSince Jun 15, 2016 Accepting new patients
Public Hospital District No 2 Skagit County Washington CurrentSince Nov 1, 2019 Accepting new patients
Franciscan Medical Group Family Medicine CurrentSince Jul 23, 2023 Accepting new patients
Public Hospital District No 2 Skagit County Washington Current Accepting new patients
Public Hospital District No 1 of Mason County Current Accepting new patients
Capital Medical Center Specialty Physicians, LLC CurrentSince Jan 2, 2013 Accepting new patients
Public Hospital District No 2 Skagit County Washington Past Accepting new patients
South Sound Health & Fitness Past Accepting new patients
South Sound Family & Sports Family Medicine Past Accepting new patients

Locations

1211 24th St
Anacortes, WA 98221
Phone (360) 293-3181

1213 24th St
Ste 100
Anacortes, WA 98221
Phone (360) 293-3101

34503 9th Ave S
Ste 130
Federal Way, WA 98003
Phone (253) 835-5340

3900 Capital Mall Dr SW
Olympia, WA 98502
Phone (360) 704-4743

901 Mountain View Dr
Shelton, WA 98584
Phone (360) 426-1611

1812 S J St
Ste 120
Tacoma, WA 98405
Phone (253) 428-2200

Interoperability endpoints

  • Direct secure messaging: jpeterson806672@fhsce.catholichealth.net

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1669553723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4804 SUNSET BEACH DRIVE NW",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "98502",
            "telephone_number": "360-867-0595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1213 24TH ST STE 100",
            "city": "ANACORTES",
            "state": "WA",
            "postal_code": "982212595",
            "telephone_number": "360-293-3101"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2960-A LIMITED LANE NW",
            "address_purpose": "LOCATION",
            "city": "Olympia",
            "state": "WA",
            "postal_code": "98502",
            "country_code": "US",
            "telephone_number": "360-709-9500",
            "fax_number": "360-754-4517",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JON",
        "middle_name": "T",
        "name_prefix": "Mr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2023-03-07",
        "certification_date": "2021-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "OP00001517",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "50D1031645",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREMERA LIFEWISE",
            "identifier": "A1825",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L & I",
            "identifier": "O186018",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUESHIELD FEDERAL",
            "identifier": "2007PE",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "3568326",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREMERA BLUE CROSS",
            "identifier": "A1820",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA STATE LICENSE",
            "identifier": "OP00001517",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA NON HMO",
            "identifier": "5617199",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DSHS",
            "identifier": "8192247",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREMERA HEALTH",
            "identifier": "A1820",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREMERA DIMENSIONS",
            "identifier": "A1820",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUESHIELD",
            "identifier": "2007PE",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US DEPT OF LABOR",
            "identifier": "601371600",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Anacortes, WA

Sources for this page

Verify at the official NPI Registry.