Jordan James Petersen, DO

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

5101028465 Issued in MI

Practice address

17000 Hubbard Dr Ste 800
Dearborn, MI 48126-4205

Phone

(313) 240-7595

NPI assigned

Jun 14, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physical Medicine and Rehabilitation

Education

Other, 2021

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Interoperability endpoints

• Direct secure messaging: jpetersen1250855@epic00.shdirect.org

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

{
    "created_epoch": "1623628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788220800000",
    "number": "1952979163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26901 BEAUMONT BLVD STE 3D",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480333849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17000 HUBBARD DR STE 800",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481264205",
            "telephone_number": "313-240-7595"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "325 E Eisenhower Pkwy",
            "address_purpose": "LOCATION",
            "city": "Ann Arbor",
            "state": "MI",
            "postal_code": "481083364",
            "country_code": "US",
            "telephone_number": "734-763-6464",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "JORDAN",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-14",
        "last_updated": "2026-09-01",
        "certification_date": "2026-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "MI",
            "license": "5101028465",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MI",
            "license": "5101028465",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jpetersen1250855@epic00.shdirect.org",
            "affiliation": "N",
            "address_1": "17000 Hubbard Dr Ste 800",
            "city": "Dearborn",
            "state": "MI",
            "country_code": "US",
            "postal_code": "481264205",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Personalized Dental Care PLLC
• Peter L. Stevenson, MD, PC
• David Peters, M.D.
• Vanessa J Peters, CRNA
• William John Peters, DPM
• Delani Alyse Peterson
• Ebony Peterson
• Michael Pauly Petrich, M.D.
• Shakyra Pettis
• Chelsea Marie Pettit, RN

• Physical Medicine & Rehabilitation Physician in Dearborn, MI
• Providers in Dearborn, MI by specialty
• Physical Medicine & Rehabilitation Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2026; 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.