Jann M Ford Petersen, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APRN8132 Issued in AZ

Practice address

3624 N Power Rd
Mesa, AZ 85215-9733

Phone

(602) 755-0800

Fax

(602) 560-2721

NPI assigned

Sep 25, 2015

Last updated

Jun 15, 2023By 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 3

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Summit Medical Group Arizona LLCGroup PAC ID 3173872835, 152 clinicians

Heavens Urgent Care LLCGroup PAC ID 7416204474, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/21922/brand/1/csg/1/fhir/r4
• Direct secure messaging: jann.ford.petersen.1@19654.direct.athenahealth.com
• Direct secure messaging: jann.petersen@299395540647940.direct.elationemr.com

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.

• Heavens Urgent Care LLC

  dba Heavens Urgent Care

  • Urgent Care Clinic/Center
  • Apache Junction, AZ
  • NPI 1578065827
  Medicare reassignment Care Compare group NPD
• Summit Medical Group Arizona LLC

  • Family Medicine Physician
  • Glendale, AZ
  • NPI 1053810622
  Medicare reassignment Care Compare group NPD
• Heavens Medical PLC

  • Clinic/Center
  • Tempe, AZ
  • NPI 1023381555
  NPD

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

{
    "created_epoch": "1443139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686787200000",
    "number": "1710357355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 24981",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049152000",
            "telephone_number": "844-969-0686",
            "fax_number": "773-832-7083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3624 N POWER RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852159733",
            "telephone_number": "602-755-0800",
            "fax_number": "602-560-2721"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "83 N Amber Ct",
            "address_purpose": "LOCATION",
            "city": "Chandler",
            "state": "AZ",
            "postal_code": "852255726",
            "country_code": "US",
            "telephone_number": "480-267-9802",
            "fax_number": "480-360-6449",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "19303 N New Tradition Rd",
            "address_purpose": "LOCATION",
            "city": "Sun City West",
            "state": "AZ",
            "postal_code": "853753806",
            "country_code": "US",
            "telephone_number": "623-624-8280",
            "fax_number": "602-835-0192",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FORD PETERSEN",
        "first_name": "JANN",
        "middle_name": "M",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-25",
        "last_updated": "2023-06-15",
        "certification_date": "2023-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AZ",
            "license": "AP8132",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "AP8132",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "APRN8132",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Foothills Sports Medicine & Rehabilitation, LLC
• Gabrielle Foppe
• Jennifer Lavonne Forbes, D.C.
• Lauren Faith Forbes
• Todd Cameron Forbes, D.C.
• Adam Ford
• Bret M Ford, DDS
• Eric Charles Ford, CNMT
• Jason Ford, LAC
• Lori Ford

• Family Nurse Practitioner in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Family Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.