Active NPI
Jordan Petersen
- Behavior Technician
- Waipahu, HI
National Provider Identifier
1992382097
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 94-849 Lumiaina St Unit 202
Waipahu, HI 96797-5677 - Phone
- (808) 294-7050
- NPI assigned
- Mar 25, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
94-849 Lumiaina St Unit 202
Waipahu, HI 96797-5677
Mailing address
16782 Von Karman Ave Ste 11
Irvine, CA 92606-2417
Phone (619) 550-6368
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250611002820 | OH | Order and Referring Only - Internal Medicine | 0446760060 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1616630400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1616630400000",
"number": "1992382097",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16782 VON KARMAN AVE STE 11",
"city": "IRVINE",
"state": "CA",
"postal_code": "926062417",
"telephone_number": "619-550-6368"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "94-849 LUMIAINA ST UNIT 202",
"city": "WAIPAHU",
"state": "HI",
"postal_code": "967975677",
"telephone_number": "808-294-7050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSEN",
"first_name": "JORDAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-03-25",
"last_updated": "2021-03-25",
"certification_date": "2021-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waipahu, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.