NPIMap

Individual provider Active NPI

Jacob Christopher Peterson, M.D.

  • Family Medicine Physician
  • Holdrege, NE
National Provider Identifier
1679954028
Registry record updated Jan 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
29451 Issued in NE
Practice address
516 W 14TH Ave Ste 100
Holdrege, NE 68949-1215
Phone
(308) 995-4431
NPI assigned
Jun 11, 2015
Last updated
Jan 25, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 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 29451 NE Primary

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 1

TypeEndpointUseAffiliation
CONNECT URL HOLDREGE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE
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
I20180507000732 NE Practitioner - Family PracticePractitioner - Other (Physician) 5294040275 Reassigns benefits to 10 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Harlan County Health System Current Accepting new patients
Sacred Heart Health Services Current Accepting new patients
West Holt Memorial Hospital Current Accepting new patients
West Holt Memorial Hospital CurrentSince Sep 25, 2023 Accepting new patients
Jennie M Melham Memorial Medical Center Inc CurrentSince Jul 22, 2022 Accepting new patients
Holdrege Medical Clinic, P.C. Family Medicine CurrentSince Nov 7, 2018 Accepting new patients
Jennie M Melham Memorial Medical Center Inc Current Accepting new patients
West Holt Memorial Hospital CurrentSince Sep 25, 2023 Accepting new patients
Avera St Anthonys Hospital 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

1215 Tibbals St
Holdrege, NE 68949
Phone (308) 995-2211

516 W 14th Ave
#100
Holdrege, NE 68949
Phone (308) 995-4431

2605 2nd Ave
Kearney, NE 68847
Phone (308) 236-7016

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/wstholt-d1685583
  • Direct secure messaging: jacobpeterson@hchs.medalliesdirect.net

Organizations & group practices 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1433980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674604800000",
    "number": "1679954028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "516 W 14TH AVE STE 100",
            "city": "HOLDREGE",
            "state": "NE",
            "postal_code": "689491215",
            "telephone_number": "308-995-4431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 W 14TH AVE STE 100",
            "city": "HOLDREGE",
            "state": "NE",
            "postal_code": "689491215",
            "telephone_number": "308-995-4431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JACOB",
        "middle_name": "CHRISTOPHER",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-11",
        "last_updated": "2023-01-25",
        "certification_date": "2021-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NE",
            "license": "29451",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "HOLDREGE",
            "affiliation": "N",
            "address_1": "516 W 14th Ave Ste 100",
            "city": "Holdrege",
            "state": "NE",
            "country_code": "US",
            "postal_code": "689491215",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Holdrege, NE

Sources for this page

Verify at the official NPI Registry.