Daniel W Peterson

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

60752 Issued in TN

Practice address

620 Skyline Dr
Jackson, TN 38301-3923

Phone

(731) 541-6026

Fax

(731) 541-7958

NPI assigned

Apr 6, 2015

Last updated

Apr 16, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

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

Pathology

Education

University of South Alabama College of Medicine, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jackson Pathology Group a Professional CorporationGroup PAC ID 9537237169, 6 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Jackson-Madison County General Hospital Hospital, Jackson, TN, CCN 440002
• Vanderbilt University Medical Center Hospital, Nashville, TN, CCN 440039
• West Tennessee Healthcare Milan Hospital Hospital, Milan, TN, CCN 440060
• Dyersburg Regional Medical Center Hospital, Dyersburg, TN, CCN 440072

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Jackson Pathology Group a Professional Corporation

  • Anatomic Pathology & Clinical Pathology Physician
  • Jackson, TN
  • NPI 1679736516
  Medicare reassignment Care Compare group NPD

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

• Dyersburg Health

  dba Dyersburg Employee Pharmacy

  • Community/Retail Pharmacy
  • Dyersburg, TN
  • NPI 1043282338

  Hospital

  Care Compare affiliation
• Jackson Madison County General Hospital

  • General Acute Care Hospital
  • Jackson, TN
  • NPI 1093705428
  Care Compare affiliation
• Milan General Hospital, Inc.

  dba West Tennessee Healthcare Milan Hospital

  • General Acute Care Hospital
  • Milan, TN
  • NPI 1699765453
  Care Compare affiliation
• Vanderbilt University Medical Center

  • General Acute Care Hospital
  • Nashville, TN
  • NPI 1396882205
  Care Compare affiliation

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

{
    "created_epoch": "1428278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618531200000",
    "number": "1992190003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8900 SPRING GRV N",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366955327",
            "telephone_number": "251-604-2152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 SKYLINE DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013923",
            "telephone_number": "731-541-6026",
            "fax_number": "731-541-7958"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17 Davis Blvd Ste 308",
            "address_purpose": "LOCATION",
            "city": "Tampa",
            "state": "FL",
            "postal_code": "336063438",
            "country_code": "US",
            "telephone_number": "813-396-2515",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "DANIEL",
        "middle_name": "W",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-04-06",
        "last_updated": "2021-04-16",
        "certification_date": "2021-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "TN",
            "license": "60752",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenneth Dewayne Perry
• Wanda Perry, CASE MANAGER
• Personal Peace Psychiatric Solutions, PLLC
• Corey Glenn Persons, O.D.
• Jerry Peters, MD
• Ebony Pettigrew
• Wendy Burks Pevahouse, APN
• Pharmacy Now, Inc
• Phillip L & Charlotte C Dennison PTRS (Scooter Unlimited, Jackson Medical Supply, Lymphedema Treatment Compan)
• Cynthia Suzette Phillips, D.PH.

• Anatomic Pathology & Clinical Pathology Physician in Jackson, TN
• Providers in Jackson, TN by specialty
• Anatomic Pathology & Clinical Pathology Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2021; 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.