DR. JED RUSSELL PETERSON (NPI# 1164634770) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164634770 |
| Entity Type | Individual |
| Full Name | DR. JED RUSSELL PETERSON |
| Credential | M.D. |
| Practice Address |
10123 Se Market St Department of Radiology Portland OR 97216-2532 |
| Practice Telephone | 5032516137 |
| Practice Fax Number | 5032616058 |
| Mailing Telephone | 5032516137 |
| Mailing Fax Number | 5032616058 |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2012-10-15 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
157199 | OR | Allopathic & Osteopathic Physicians |
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
MD.60212410 | WA | Allopathic & Osteopathic Physicians |
| Y | 2085R0204X |
Radiology Specialization: Vascular & Interventional Radiology |
157199 | OR | Allopathic & Osteopathic Physicians |
| N | 2085R0204X |
Radiology Specialization: Vascular & Interventional Radiology |
MD.60212410 | WA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | MEDICAL LICENSE NUMBER | MD60212410 | 01 |
| OR | OREGON MEDICAL BOARD | 157199 | 01 |
| Street Address |
10123 SE MARKET ST DEPARTMENT OF RADIOLOGY |
| City | PORTLAND |
| State | OR |
| Zip Code | 97216-2532 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801887658 | Portland Adventist Medical Center | General Acute Care Hospital | 10123 Se Market St, Portland, OR 97216 | 2005-11-01 |
| 1619504495 | Sandy Thao Mai Ninh | Pharmacist | 10123 Se Market St, Portland, OR 97216-2532 | 2020-03-24 |
| 1154957298 | Rachel Anne Dalton | Speech-Language Pathologist | 10123 Se Market St, Portland, OR 97216-2532 | 2020-03-20 |
| 1497388797 | Brooke Ottman | Registered Nurse | 10123 Se Market St, Portland, OR 97216-2532 | 2020-02-15 |
| 1316502719 | Portland Adventist Medical Center | Emergency Medicine | 10123 Se Market St, Portland, OR 97216-2532 | 2019-05-01 |
| 1548749096 | Hospitalist Medicine Physicians of Oregon-tcg, PC | Internal Medicine | 10123 Se Market St, Portland, OR 97216-2532 | 2018-08-07 |
| 1144713876 | Patrick Caloz | Physician Assistant | 10123 Se Market St, Portland, OR 97216-2599 | 2018-06-07 |
| 1902304413 | Rachael Veith | Dietitian, Registered | 10123 Se Market St, Portland, OR 97216-2532 | 2018-01-30 |
| 1073027447 | Christine Guppenberger | Physician Assistant | 10123 Se Market St, Portland, OR 97216-2532 | 2017-11-21 |
| 1215459110 | Theresa Lynne Stratton | Registered Nurse | 10123 Se Market St, Portland, OR 97216-2532 | 2017-07-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316468341 | Accident Care Chiropractic and Massage of Salem | Clinic/Center | 2168 Lancaster Dr. Ne, Portland, OR 97216 | 2017-06-29 |
| 1528508520 | Damone Brown | Peer Specialist | 10209 Se Washington St, Suite D, Portland, OR 97216 | 2017-02-24 |
| 1861937237 | Malachai Investments LLC | Clinical Medical Laboratory | 10,000 Se Main St, Ste 360, Portland, OR 97216 | 2016-12-21 |
| 1881136836 | Krista Marie Darnell | Occupational Therapy Assistant | 1475, Se 100th Avenue, Portland, OR 97216 | 2016-11-08 |
| 1821456559 | Sean Kelly | Counselor | 10564 Se Washington Street, Portland, OR 97216 | 2016-02-09 |
| 1174908321 | Phil Bergland | Counselor | 11220 Se Stark St, Suite 6, Portland, OR 97216 | 2015-07-29 |
| 1134507346 | Beth Lopez | Massage Therapist | 5814 Se Stark Street, Portland, OR 97216 | 2015-05-08 |
| 1982081477 | Amelia C Hunt | Counselor | 10564 Se Washinton Street, Portland, OR 97216 | 2015-05-04 |
| 1073907978 | Karen Ta | Emergency Medicine | 10300 Se Main St, Portland, OR 97216 | 2015-03-27 |
| 1265823298 | Laura Catherine Anderson | Occupational Therapist | 1475 Se 100th Avenue, Portland, OR 97216 | 2015-02-12 |
| Find all providers in zip 97216 | ||||
| Taxonomy Code | 2085R0204X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Vascular & Interventional Radiology |
| A radiologist who diagnoses and treats diseases by various radiologic imaging modalities. These include fluoroscopy, digital radiography, computed tomography, sonography and magnetic resonance imaging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194282400 | Comprehensive Interventional Care Centers, Pllc | Radiology | 6958 Sw Varns St, Portland, OR 97223-0000 | 2019-02-22 |
| 1538587118 | Masahiro Horikawa | Radiology | 3155 Sw Moody Ave Apt 503, Portland, OR 97239-4733 | 2014-04-01 |
| 1073956991 | Marc Michael Delrosario Lim | Radiology | 3181 Sw Sam Jackson Park Rd # L342, Portland, OR 97239-3011 | 2013-04-10 |
| 1588283154 | Pnw Management Group | Radiology | 6958 Sw Varns St, Portland, OR 97223-8281 | 2020-04-13 |
| 1780149260 | Radiology Professionals, P.a. | Radiology | 144 State Street, Portland, ME 04101-3776 | 2019-02-08 |
| 1669905261 | Ningcheng Li | Radiology | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239 | 2017-04-10 |
| 1669868741 | Lisa Walker | Radiology | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011 | 2015-04-15 |
| 1336568369 | Hasnain A Hasham | Radiology | 4805 Ne Glisan St Ste 11n, Portland, OR 97213-2933 | 2014-04-07 |
| 1689917866 | Timothy Huber | Radiology | 3181 Sw Sam Jackson Park Rd # L605, Portland, OR 97239-3011 | 2013-04-05 |
| 1396036620 | Nutcha Pinjaroen | Radiology | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011 | 2011-04-20 |
| Find all providers in PORTLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.