Jerald Miles Petersen, MD in Mount Horeb, WI

Jerald Miles Petersen, MD is a medicare enrolled "Hospitalist" physician in Mount Horeb, Wisconsin. His current practice location is 1275 Lindokken Rd Ste 315, Mount Horeb, Wisconsin. You can reach out to his office (for appointments etc.) via phone at (000) 000-0000.

Jerald Miles Petersen is licensed to practice in Wisconsin (license number 64866) 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 1649209032.

Contact Information

	Jerald Miles Petersen, MD
	1275 Lindokken Rd Ste 315, Mount Horeb, WI 53572-9701
	(000) 000-0000
	Not Available

Map and Direction

Physician's Profile

Full Name	Jerald Miles Petersen
Gender	Male
Speciality	Hospitalist
Location	1275 Lindokken Rd Ste 315, Mount Horeb, Wisconsin
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1649209032
Provider Enumeration Date: 06/30/2006
Last Update Date: 02/13/2022

Medicare PECOS Information:

PECOS PAC ID: 6709930191
Enrollment ID: I20160114001799

Medical Identifiers

Medical identifiers for Jerald Miles Petersen such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1649209032	NPI	-	NPPES
732880000	Medicaid	MN

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
208M00000X	Hospitalist	64866 (Wisconsin)	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. Jerald Miles Petersen allows following entities to bill medicare on his behalf.

Entity Name	Meriter Hospital Inc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1548280225 PECOS PAC ID: 3971412735 Enrollment ID: O20031126000346

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. Jerald Miles 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
Jerald Miles Petersen, MD 1275 Lindokken Rd, Mount Horeb, WI 53572-9701 Ph: () -	Jerald Miles Petersen, MD 1275 Lindokken Rd Ste 315, Mount Horeb, WI 53572-9701 Ph: (000) 000-0000

Jerald Miles Petersen, MD - Medicare Hospitalist in Mount Horeb, WI