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JEFFRY LYNES PETERSON CRNA
NPI 1164569729
Nurse Anesthetist, Certified Registered in Red Bud, IL

Active since January 31, 2007PECOS EnrolledAccepts Medicare Assignment
100/100
CMS Quality Rating
10117 PINE CREST RD, RED BUD, IL 62278(618) 282-2872 Get Directions Write a Review

NPPES record last updated: May 29, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: May 29, 2026, Feb 4, 2020 (2 updates tracked since 2020).

About Jeffry Lynes Peterson Crna NPPES

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

JEFFRY LYNES PETERSON CRNA (NPI 1164569729) is an individual nurse anesthetist, certified registered in Red Bud, Illinois, licensed in Kentucky (3002489) and active in the NPI registry since January 2007. He is enrolled in Medicare PECOS, is affiliated with Memorial Hospital, and maintains a secondary practice location in Sparta.

NPPES Registry Identity

NPI1164569729
Entity TypeIndividualMale
Primary Taxonomy367500000X
Provider Legal NameJEFFRY LYNES PETERSONCredential: CRNA
Location Address10117 PINE CREST RDRed Bud, IL 62278-4458
Mailing Address10117 Pine Crest RdRed Bud, IL 62278-4458 · (270) 898-1922
Phone(618) 282-2872
Sole ProprietorNo
Medical School CMSOtherGraduated 1997
Enumeration DateJanuary 31, 2007
Last NPPES UpdateMay 29, 20262 updates tracked since enumeration
NPPES CertifiedMay 29, 2026
✔ NPI 1164569729 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code367500000X
Licenses✔ Licensed in KY · 3002489✔ Licensed in MO · 124294✔ Licensed in IL · 209-000383
Definition
(1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition.
10117 PINE CREST RD, Red Bud, IL 62278
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Secondary Practice Location 1

Location 1818 E Broadway StSparta, IL 62286-1820 · Phone (618) 443-2177 · Fax (618) 443-1380

Other Identifiers 1

Medicaid7424890700KY

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jeffry Lynes Peterson Crna is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8729164397
PECOS Enrollment IDI20120927000800
Eligible to Order & Refer✔ Part B Labs & Imaging– Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

5

Medicare enrollment records show Jeffry Peterson reassigns Medicare billing to 5 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Sparta Community Hospital
18 mi
Critical Access
818 E BROADWAY ST
Sparta, IL 62286
  • Reassigned Medicare billing, Illinois enrollment
  • 23 clinicians in this Medicare group
NPI 1548216476 (618) 443-2177
Sparta Community Hospital D/B/A Quality Healthcare Clinics
18 mi
Multi-Specialty
818 E. BROADWAY STREET
Sparta, IL 62286
  • Reassigned Medicare billing, Illinois enrollment
  • 51 clinicians in this Medicare group
NPI 1114984226 (618) 443-1337
Memorial Hospital
21 mi
Critical Access
1900 STATE ST
Chester, IL 62233
  • Reassigned Medicare billing, Illinois enrollment
  • 62 clinicians in this Medicare group
NPI 1851390132 (618) 826-4581
Aim Anesthesia LLC
45 mi
Anesthesiology
3550 MCKELVEY ROAD, PREMIER SURGERY CENTER
Bridgetown, MO 63044
  • Reassigned Medicare billing, Missouri enrollment
  • 49 clinicians in this Medicare group
NPI 1245685601 (314) 741-0911
St. Mary's Hospital, Centralia, Illinois
54 mi
Anesthesiology
400 N PLEASANT AVE
Centralia, IL 62801
  • Reassigned Medicare billing, Illinois enrollment
  • Medicare enrollment name: St Marys Hospital Centralia Illinois
  • 392 clinicians in this Medicare group
NPI 1477097871 (618) 436-6056

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Anesthesia for other procedure on large bowel using an endoscope 00811
Anesthesia for an endoscopic procedure on the large bowel ensures comfort and relaxation during the procedure. You'll be given medication to make you drowsy or asleep, eliminating any discomfort. The medication can be administered through a vein or inhaled.
16 services16 patients
Anesthesia for lens surgery 00142
Anesthesia for lens surgery involves administering medication to numb the eye area, ensuring you feel no pain during the procedure. This can be a local anesthetic (numbing only the eye area) or general (where you're asleep). It helps make the surgery comfortable and stress-free.
15 services14 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Memorial Hospital

Critical Access Hospitals · Chester, IL
OwnershipGovernment - Hospital District or Authority
CMS Certification Number141338
Location1900 State StChester, IL 62233 · Randolph County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 62278 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
$131.14 typical visit price
range $56.28 – $173.35
Typical copayment $32.78 (range $14.07 – $43.33)
Most-billed visit code 99204
Established Patient
$70.42 typical visit price
range $17.51 – $139.99
Typical copayment $17.60 (range $4.37 – $34.99)
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.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

100/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Promoting Interoperability100
Improvement Activities40

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 Jeffry Peterson's NPI number?

The NPI number for Jeffry Peterson is 1164569729. It was assigned to this individual provider in the NPPES registry on January 31, 2007.

Where is Jeffry Peterson located?

Jeffry Peterson practices at 10117 Pine Crest Rd, Red Bud, IL 62278. The listed phone number is (618) 282-2872.

What is Jeffry Peterson's specialty?

The primary specialty registered for this NPI is Nurse Anesthetist, Certified Registered with taxonomy code 367500000X.

Is Jeffry Peterson enrolled in Medicare?

Yes. Jeffry Peterson is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Jeffry Peterson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jeffry Peterson reassigns Medicare benefits to 5 organizations: Sparta Community Hospital (Sparta, IL), Sparta Community Hospital D/B/A Quality Healthcare Clinics (Sparta, IL), Memorial Hospital (Chester, IL), Aim Anesthesia LLC (Bridgetown, MO) and St. Mary's Hospital, Centralia, Illinois (Centralia, IL). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jeffry Peterson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

Is Jeffry Peterson affiliated with any hospitals?

According to CMS data, Jeffry Peterson is affiliated with Memorial Hospital.

When was this NPI record last updated?

The NPPES record for Jeffry Peterson was last updated on May 29, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 months 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.