DR. JON FREDRICK PETERSEN (NPI# 1285621516) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285621516 |
| Entity Type | Individual |
| Full Name | DR. JON FREDRICK PETERSEN |
| Credential | M.D. |
| Practice Address |
1750 E Lake Shore Dr Decatur IL 62521-3803 |
| Practice Telephone | 2174641440 |
| Practice Fax Number | 2174641469 |
| Mailing Telephone | 2174641440 |
| Mailing Fax Number | 2174641469 |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2016-10-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | 036129728 | IL | Allopathic & Osteopathic Physicians |
| Y | 2083X0100X |
Preventive Medicine Specialization: Occupational Medicine |
036129728 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| HEALTHLINK | 250766 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831735141 | Jon Walter Petersen | Counselor | 4136 Queen Ave S Apt 100, Minneapolis, MN 55410-1254 | 2019-11-21 |
| 1396937330 | Jon R Petersen | Massage Therapist | 1307 Court St, Mchenry, IL 60050-4422 | 2007-08-14 |
| Street Address |
1750 E LAKE SHORE DR |
| City | DECATUR |
| State | IL |
| Zip Code | 62521-3803 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265947451 | Antoniannette Pate | Nurse Practitioner | 1750 E Lake Shore Dr, Decatur, IL 62521-3803 | 2017-12-10 |
| 1578093225 | Jason Blanchetti | Nurse Practitioner | 1750 E Lake Shore Dr, Decatur, IL 62521-3803 | 2017-06-15 |
| 1992182331 | Alyson Webb | Nurse Practitioner | 1750 E Lake Shore Dr, Ste 310, Decatur, IL 62521-3803 | 2015-05-06 |
| 1932527017 | Adills Moosa | Preventive Medicine | 1750 E Lake Shore Dr, Decatur, IL 62521-3803 | 2014-04-04 |
| 1841579026 | Justin William Kierbs | Nurse Practitioner | 1750 E Lake Shore Dr, Suite 200, Decatur, IL 62521-3803 | 2011-08-05 |
| 1194012260 | Nikesh Lath | Surgery | 1750 E Lake Shore Dr, Decatur, IL 62521-3803 | 2011-07-08 |
| 1922319839 | Chinelo C Echeazu | Obstetrics & Gynecology | 1750 E Lake Shore Dr, Suite 110, Decatur, IL 62521 | 2010-06-24 |
| 1215267596 | Vikram S Kotwal | Internal Medicine | 1750 E Lake Shore Dr, Suite 310, Decatur, IL 62521-3803 | 2010-01-08 |
| 1396073813 | Mohammed A. Rahman | Neurological Surgery | 1750 E Lake Shore Dr, 110, Decatur, IL 62521-3803 | 2009-11-20 |
| 1750617007 | Randi Rigsby | Nurse Practitioner | 1750 E Lake Shore Dr, Suite 100, Decatur, IL 62521-3803 | 2009-10-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053927988 | Caleb David Braasch | Pharmacist | 1818 South Airport Rd, Decatur, IL 62521 | 2020-09-16 |
| 1295390490 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | Crossing Recovery Center, 495 East Central Ave, Decatur, IL 62521 | 2019-05-03 |
| 1396300638 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | 495 E Central Ave, Decatur, IL 62521 | 2019-05-02 |
| 1679138911 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | 495 East Central Ave, Decatur, IL 62521 | 2019-05-02 |
| 1154848034 | Zack Shaw | Physical Therapist | 4855-57 East 36, Decatur, IL 62521 | 2017-08-23 |
| 1790032852 | Prashant Morolia | Family Medicine | 4775 E Maryland St, Decatur, IL 62521 | 2012-08-08 |
| 1003188913 | Evergreen Place Decatur, LLC | Assisted Living Facility | 4825 E Evergreen Court, Decatur, IL 62521 | 2012-02-08 |
| 1104133099 | Suzette Marie Shafer | Occupational Therapy Assistant | 1790 S. Fairview Ave., Decatur, IL 62521 | 2010-09-13 |
| 1467784090 | Community Health Improvement Center | Clinic/Center | 1221 East Condit Street, Decatur, IL 62521 | 2010-02-08 |
| 1982839056 | Kelly Clark Dds PC | Dentist | 3737 Us Rt 36 E, Decatur, IL 62521 | 2009-05-19 |
| Find all providers in zip 62521 | ||||
| Taxonomy Code | 2083X0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Preventive Medicine |
| Specialization | Occupational Medicine |
| Occupational medicine focuses on the health of workers, including the ability to perform work; the physical, chemical, biological, and social environments of the workplace; and the health outcomes of environmental exposures. Practitioners in this field address the promotion of health in the work place, and the prevention and management of occupational and environmental injury, illness, and disability. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Preventive Medicine, 2007. http://www.abprevmed.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Preventive Medicine. |
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|---|---|---|---|---|
| 1801305024 | U.S. Healthworks Medical Group of Georgia, Inc. | Preventive Medicine | 1045 Sycamore Dr, Decatur, GA 30030-1645 | 2017-09-20 |
| 1932527017 | Adills Moosa | Preventive Medicine | 1750 E Lake Shore Dr, Decatur, IL 62521-3803 | 2014-04-04 |
| 1023310638 | Georgia Injury & Spine Center of Decatur | Preventive Medicine | 2417 Candler Rd, Decatur, GA 30032-6410 | 2010-12-02 |
| 1952552929 | Dekalb Medical Occupational Medicine Group LLC | Preventive Medicine | 2701 N Decatur Rd, Decatur, GA 30033-5918 | 2008-10-08 |
| 1235353483 | Darvin Keith Suter | Preventive Medicine | 1100 Mercer Ave, Decatur, IN 46733-2303 | 2007-04-12 |
| 1609925528 | Freddy Glenn Mcmurry | Preventive Medicine | 1615 Kathy Ln Sw, Decatur, AL 35603-1026 | 2007-01-09 |
| 1609829308 | Jorge E Simmonds-diaz | Preventive Medicine | 445 Winn Way, Decatur, GA 30030-1707 | 2006-05-17 |
| 1144287020 | John H Fahey | Preventive Medicine | 2975 N Water St, Decatur, IL 62526-4235 | 2006-04-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356816466 | Taylor Nicole Rich | Preventive Medicine | 2408 Hampshire Dr Apt 2, Champaign, IL 61820-1215 | 2018-10-05 |
| 1720517568 | Avrom Simon | Preventive Medicine | 128 S Aberdeen St Unit 5s, Chicago, IL 60607-1507 | 2017-06-06 |
| 1215332531 | Cheryl Culberson | Preventive Medicine | 350 Surryse Rd Ste 110, Lake Zurich, IL 60047-3217 | 2014-10-29 |
| 1497018493 | Brian Charles Svazas | Preventive Medicine | 211 Kenilworth Ave, Glen Ellyn, IL 60137-5324 | 2012-06-25 |
| 1205129764 | Zbigniev Durlak | Preventive Medicine | 9930 Stratford L, Palos Hills, IL 60465 | 2011-05-17 |
| 1609168657 | New Life Pentecostal Medical Clinic for The Uninsured Inc | Preventive Medicine | 183 N Schuyler Ave, Kankakee, IL 60901-3828 | 2011-05-10 |
| 1821305269 | Daniel Alexander Bakston | Preventive Medicine | 835 S. Wolcott Ave E-144, University of Illinois Medical Center, Chicago, IL 60612-4006 | 2010-09-07 |
| 1194951913 | Sonya Meyers | Preventive Medicine | 835 S Wolcott Ave # E144, Chicago, IL 60612-3748 | 2009-06-08 |
| 1073755021 | Afiz A. Taiwo, Md. Mph. S.c. | Preventive Medicine | 309 Pinehurst Dr, Palos Heights, IL 60463-2911 | 2009-04-06 |
| 1104077494 | William Dawson | Preventive Medicine | 700 Woodmere Ln, Glenview, IL 60025-4469 | 2008-10-04 |
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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.