NPIMap

Individual provider Active NPI

Jeremy Petzold, PA

  • Physician Assistant
  • Saginaw, MI
National Provider Identifier
1962090845
Registry record updated Nov 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601010356 Issued in MI
Practice address
3875 Bay Rd Ste 2S
Saginaw, MI 48603-2423
Phone
(989) 583-5370
Fax
(989) 583-1872
NPI assigned
Jan 6, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601010356 MI Primary

Addresses

Primary practice location

3875 Bay Rd Ste 2S
Saginaw, MI 48603-2423

Mailing address

1447 N Harrison St
Saginaw, MI 48602-4727
Phone (989) 583-0000

Other practice location 1

2726 N Saginaw Rd
Midland, MI 48640-2633
Phone (989) 583-5370

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20210120000211 MI Practitioner - Physician Assistant 7719390483 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Covenant Medical Center, Inc.Group PAC ID 2769387778, 488 clinicians

Practice addresses (Care Compare)

1447 N Harrison St
Saginaw, MI 48602-4727
Phone (989) 583-4220

1941 Gates St
Reese, MI 48757-9555
Phone (989) 583-5550

3875 Bay Rd
Saginaw, MI 48603-2423

700 Cooper Ave
Saginaw, MI 48602-5383
Phone (989) 583-4220

900 Cooper Ave
Saginaw, MI 48602-5182

Hospital & facility affiliations

  • Covenant Medical Center Hospital, Saginaw, MI, CCN 230070
  • Mymichigan Medical Center Midland Hospital, Midland, MI, CCN 230222
  • Scheurer Hospital Hospital, Pigeon, MI, CCN 231310
  • Mymichigan Medical Center Clare Hospital, Clare, MI, CCN 230180
  • Hills & Dales General Hospital Hospital, Cass City, MI, CCN 231316

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Covenant Medical Center, Inc CurrentSince Mar 1, 2021 Accepting new patients
Covenant Medical Center, Inc. CurrentSince Mar 1, 2021 Accepting new patients

Locations

3875 Bay Rd
Ste 2S
Saginaw, MI 48603
Phone (989) 583-5370

1447 N Harrison St
Saginaw, MI 48602
Phone (989) 583-4220

Interoperability endpoints

  • Direct secure messaging: jpetzold99376@direct.covenanthealthcare.com

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 18

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1609891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698883200000",
    "number": "1962090845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1447 N HARRISON ST",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486024727",
            "telephone_number": "989-583-0000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3875 BAY RD STE 2S",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486032423",
            "telephone_number": "989-583-5370",
            "fax_number": "989-583-1872"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2726 N Saginaw Rd",
            "address_purpose": "LOCATION",
            "city": "Midland",
            "state": "MI",
            "postal_code": "486402633",
            "country_code": "US",
            "telephone_number": "989-583-5370",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETZOLD",
        "first_name": "JEREMY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-01-06",
        "last_updated": "2023-11-02",
        "certification_date": "2023-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601010356",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saginaw, MI

Sources for this page

Verify at the official NPI Registry.