Jacob Christopher Peterson, M.D.
Individual provider Active NPI Family Medicine Physician · Holdrege, NE
NPI 1679954028 · NPPES record last updated Jan 25, 2023
Key facts
- NPI
- 1679954028
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 29451 (NE)
- Practice address
- 516 W 14TH Ave Ste 100
Holdrege, NE 68949-1215 - Phone
- (308) 995-4431
- NPI assigned
- Jun 11, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 12
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NE
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180507000732 | NE | Practitioner - Family Practice |
5294040275 | Reassigns benefits to 10 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| West Holt Memorial Hospital | Current | Accepting new patients | |
| Sacred Heart Health Services | Current | Accepting new patients | |
| West Holt Memorial Hospital | Current |
Accepting new patients | |
| Jennie M Melham Memorial Medical Center Inc | Current |
Accepting new patients | |
| West Holt Memorial Hospital | Current |
Accepting new patients | |
| Avera St Anthonys Hospital | Current | Accepting new patients | |
| Holdrege Medical Clinic, P.C. | Family Medicine | Current |
Accepting new patients |
| Harlan County Health System | Current | Accepting new patients | |
| Jennie M Melham Memorial Medical Center Inc | Current | Accepting new patients | |
| West Holt Memorial Hospital | Current | Accepting new patients |
Locations
717 Brown St
Alma, NE 68920
Phone (308) 928-2151
405 W Pearl St
Atkinson, NE 68713
Phone (402) 925-2631
406 W Neely St
Atkinson, NE 68713
Phone (402) 925-2811
516 W 14th Ave
#100
Holdrege, NE 68949
Phone (308) 995-4431
1215 Tibbals St
Holdrege, NE 68949
Phone (308) 995-2211
2605 2nd Ave
Kearney, NE 68847
Phone (308) 236-7016
Interoperability endpoints
- https://fhir-usa.unify.chbase.com/org/wstholt-d1685583
- jacobpeterson@hchs.medalliesdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 29451 | NE | Yes |
Addresses
Primary practice location
516 W 14TH Ave Ste 100
Holdrege, NE 68949-1215
Mailing address
516 W 14TH Ave Ste 100
Holdrege, NE 68949-1215
Phone (308) 995-4431
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | HOLDREGE |
Other providers in Holdrege, NE
- Brett Pascoe
- Sara Payton
- Sarah Jayne Pelton
- Kimberlee Penny
- Hulda Peterson
- Dana Petit
- Phelps County School District 69-0044
- Phelps Memorial Health Center
- Phelps Memorial Health Center
- Phelps Memorial Health Center
All providers in Holdrege, NE · Family Medicine Physician in Nebraska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 25, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.