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MRS. MICHELLE ANNMARIE JACKSON PETERSEN NP
NPI 1205548443
Nurse Practitioner - Family in Astoria, NY

Active since December 20, 2022PECOS EnrolledAccepts Medicare Assignment
2322 30TH RD STE 1A, ASTORIA, NY 11102(667) 326-9198 Get Directions Write a Review

NPPES record last updated: October 30, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Mrs. Michelle Annmarie Jackson Petersen Np NPPES

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

MRS. MICHELLE ANNMARIE JACKSON PETERSEN NP (NPI 1205548443) is an individual family provider in Astoria, New York, licensed in New York (F348339-01) and active in the NPI registry since December 2022. She is enrolled in Medicare PECOS and is a graduate of Other (2021).

NPPES Registry Identity

NPI1205548443
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameMRS. MICHELLE ANNMARIE JACKSON PETERSENCredential: NP
Location Address2322 30TH RD STE 1AAstoria, NY 11102-3238
Mailing Address21917 130th DrSpringfield Gardens, NY 11413-1220 · (718) 276-2651
Phone(667) 326-9198
Sole ProprietorYes
Medical School CMSOtherGraduated 2021
Enumeration DateDecember 20, 2022
Last NPPES UpdateOctober 30, 2024
NPPES CertifiedOctober 30, 2024
✔ NPI 1205548443 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in NY · F348339-01
2322 30TH RD STE 1A, Astoria, NY 11102
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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

Mrs. Michelle Annmarie Jackson Petersen Np 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 ID6507397452
PECOS Enrollment IDI20241002001406
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

2

Medicare enrollment records show Michelle Jackson Petersen reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Jamaica Hospital
7.4 mi
Emergency Medical Services
8900 VAN WYCK EXPWY
Jamaica, NY 11418
  • Reassigned Medicare billing, New York enrollment
  • 738 clinicians in this Medicare group
NPI 1477505220 (718) 206-8918
Laurelton Medical Physicians PLLC
11 mi
Clinic/Center
22414 MERRICK BLVD
Laurelton, NY 11413
  • Reassigned Medicare billing, New York enrollment
  • 7 clinicians in this Medicare group
NPI 1902216229 (718) 949-6433

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

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 11102 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
$104.17 typical visit price
range $67.00 – $201.98
Typical copayment $26.04 (range $16.75 – $50.49)
Most-billed visit code 99203
Established Patient
$116.96 typical visit price
range $21.62 – $163.52
Typical copayment $29.24 (range $5.40 – $40.88)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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 Michelle Jackson Petersen's NPI number?

The NPI number for Michelle Jackson Petersen is 1205548443. It was assigned to this individual provider in the NPPES registry on December 20, 2022.

Where is Michelle Jackson Petersen located?

Michelle Jackson Petersen practices at 2322 30th Rd Ste 1A, Astoria, NY 11102. The listed phone number is (667) 326-9198.

What is Michelle Jackson Petersen's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Michelle Jackson Petersen enrolled in Medicare?

Yes. Michelle Jackson Petersen 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 Michelle Jackson Petersen's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Michelle Jackson Petersen reassigns Medicare benefits to 2 organizations: Jamaica Hospital (Jamaica, NY) and Laurelton Medical Physicians PLLC (Laurelton, NY). 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 Michelle Jackson Petersen's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Michelle Jackson Petersen was last updated on October 30, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 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.