Jack A Peterson, D.O.
Individual provider Active NPI Family Medicine Physician · Cochranton, PA
NPI 1790717163 · NPPES record last updated Jul 6, 2021
Key facts
- NPI
- 1790717163
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- OS008804L (PA)
- Practice address
- 180 N Franklin St Ste B
Cochranton, PA 16314-9706 - Phone
- (814) 424-1126
- Fax
- (814) 251-1568
- NPI assigned
- Jul 7, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 16
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Des Moines University of Osteopathic Medicine and Health Sciences
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Primary Care Services
Keystone Rehabilitation Systems Inc
Practice addresses (Care Compare)
180 N Franklin St
Suite B
Cochranton, PA 16314-9706
Phone (814) 425-1126
316 Allegheny Blvd
Suite B
Franklin, PA 16323-6208
Phone (814) 432-7200
Hospital & facility affiliations
- Vna Alliance
- Hospice of Crawford County Inc
- Meadville Medical Center
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
| Removal or shaving of skin growth | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
- 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 |
|---|---|---|---|---|
| I20120328000644 | PA | Practitioner - Family Practice | 2163682113 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Primary Care Services | Family Medicine | Current |
Accepting new patients |
Locations
180 N Franklin St
#B
Cochranton, PA 16314
Phone (814) 333-7020
12387 Conneaut Lake Rd
Conneaut Lake, PA 16316
Phone (814) 373-4298
765 Liberty St
Ste 307
Meadville, PA 16335
Phone (814) 336-1140
1034 Grove St
Meadville, PA 16335
Phone (814) 333-5728
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | OS008804L | PA | Yes |
Addresses
Primary practice location
180 N Franklin St Ste B
Cochranton, PA 16314-9706
Mailing address
1034 Grove St
Meadville, PA 16335-2945
Phone (814) 425-1126
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00163946000003 | Medicaid | PA |
Other providers in Cochranton, PA
- Maryann Yusko Lukowich
- MMC Pharmacy Inc
- MMC Pharmacy Inc
- Northwest Pharmacy Solutions LLC
- Northwest Pharmacy Solutions LLC
- Benjamin Roberts
- Chad Nicholas Robinson
- Katelyn Sheehan
- The Cochranton Volunteer Fire Department and Relief Association
- William Scott Wolfe
All providers in Cochranton, PA · Family Medicine Physician in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 6, 2021. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.