Dr Jacob Petersen, DPT is a medicare enrolled "Physical Medicine & Rehabilitation" physician in Pinole, California. His current practice location is
2160 Appian Way, Suite 101, Pinole, California. You can reach out to his office (for appointments etc.) via phone at
(510) 724-1248.
Dr Jacob Petersen is licensed to practice in California (license number 291765) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1811440274.
Physician's Profile
| Full Name | Dr Jacob Petersen |
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| Gender | Male |
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| Speciality | Physical Medicine & Rehabilitation |
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| Location | 2160 Appian Way, Pinole, California |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1811440274
- Provider Enumeration Date: 08/02/2016
- Last Update Date: 08/02/2016
Medicare PECOS Information:
- PECOS PAC ID: 1456703578
- Enrollment ID: I20240113000697
Medical Identifiers
Medical identifiers for Dr Jacob Petersen such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1811440274 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 208100000X | Physical Medicine & Rehabilitation | 291765 (California) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Jacob Petersen allows following entities to bill medicare on his behalf.
| Entity Name | Spooner Physical Therapy & Hand Rehab, Pc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1184730095
PECOS PAC ID: 3476440447
Enrollment ID: O20040303000811 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Jacob Petersen is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Jacob Petersen, DPT
8874 Woodmayr Cir,
Norwalk, IA 50211-1842
Ph: () - | Dr Jacob Petersen, DPT
2160 Appian Way, Suite 101,
Pinole, CA 94564-2576
Ph: (510) 724-1248 |
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