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JAKE ALLEN PETERSON DDS, MD
NPI 1043657364
Dentist - Oral and Maxillofacial Surgery in Bend, OR

Active since May 28, 2013Opted out of Medicare · through Sep 13, 2026
1475 SW CHANDLER AVE STE 101, BEND, OR 97702(541) 617-3993 Get Directions Write a Review

NPPES record last updated: March 1, 2022. Verified against the NPPES registry weekly; last sync: August 30, 2026.

Record update history: Mar 1, 2022, Aug 18, 2020, Jun 10, 2019 and 1 more (4 updates tracked since 2016).

About Jake Allen Peterson Dds, Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JAKE ALLEN PETERSON DDS, MD (NPI 1043657364) is an individual oral and maxillofacial surgery provider in Bend, Oregon, licensed in Idaho (D-5107-OS) and active in the NPI registry since May 2013. He has opted out of Medicare through September 13, 2026 and remains eligible to order and refer and maintains a secondary practice location in Bend.

NPPES Registry Identity

NPI1043657364
Entity TypeIndividualMale
Primary Taxonomy1223S0112X
Provider Legal NameJAKE ALLEN PETERSONCredential: DDS, MD
Location Address1475 SW CHANDLER AVE STE 101Bend, OR 97702-3239
Mailing Address1475 Sw Chandler Ave Ste 101Bend, OR 97702-3239 · (541) 617-3993
Phone(541) 617-3993
Sole ProprietorYes
Enumeration DateMay 28, 2013
Last NPPES UpdateMarch 1, 20224 updates tracked since enumeration
NPPES CertifiedMarch 1, 2022
✔ NPI 1043657364 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers
Taxonomy Code1223S0112X
Licenses✔ Licensed in ID · D-5107-OS✔ Licensed in ID · M-15171✔ Licensed in WA · DE60941667
Definition
An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
1475 SW CHANDLER AVE STE 101, Bend, OR 97702
Open in Google Maps ↗

Secondary Practice Location 1

Location 11475 NE Williamson BlvdBend, OR 97701-6038 · Phone (541) 382-1053

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Jake Allen Peterson Dds, Md has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from September 13, 2022 through September 13, 2026.

Opt-Out Effective DateSeptember 13, 2022
Opt-Out In Effect ThroughSeptember 13, 2026Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 97702 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$84.82 typical visit price
range $54.96 – $166.64
Typical copayment $21.20 (range $13.74 – $41.66)
Most-billed visit code 99203
Established Patient
$68.64 typical visit price
range $17.68 – $136.19
Typical copayment $17.16 (range $4.42 – $34.04)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

K & L OMS LLC
Clinic/Center (Oral and Maxillofacial Surgery)
1475 SW CHANDLER AVE STE 101
BEND, OR 97702
Deschutes County (541) 617-3993

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jake Peterson's NPI number?

The NPI number for Jake Peterson is 1043657364. It was assigned to this individual provider in the NPPES registry on May 28, 2013.

Where is Jake Peterson located?

Jake Peterson practices at 1475 SW Chandler Ave Ste 101, Bend, OR 97702. The listed phone number is (541) 617-3993.

What is Jake Peterson's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Is Jake Peterson enrolled in Medicare?

No. Jake Peterson has opted out of Medicare through September 13, 2026. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Jake Peterson was last updated on March 1, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.