JEDIDIAH ALLEN PETERSEN PA
NPI 1366870206
Physician Assistant in Polson, MT

Active since October 30, 2013PECOS EnrolledAccepts Medicare Assignment
6 13TH AVE E, POLSON, MT 59860(406) 883-5680(406) 883-8960 Get Directions Write a Review

NPPES record last updated: December 8, 2015. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Jedidiah Allen Petersen Pa NPPES

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

JEDIDIAH ALLEN PETERSEN PA (NPI 1366870206) is an individual physician assistant in Polson, Montana, licensed in Idaho (PA-1110) and active in the NPI registry since October 2013. He is enrolled in Medicare PECOS, is affiliated with St. Patrick Hospital, and is a graduate of Other (2013).

NPPES Registry Identity

NPI1366870206
Entity TypeIndividualMale
Primary Taxonomy363A00000X
Provider Legal NameJEDIDIAH ALLEN PETERSENCredential: PA
Location Address6 13TH AVE EPolson, MT 59860-5315
Mailing AddressPo Box 262Liberty Lake, WA 99019-0262 · (208) 232-7862 · Fax (208) 232-7869
Fax(406) 883-8960
Sole ProprietorNo
Medical School CMSOtherGraduated 2013
Enumeration DateOctober 30, 2013
Last NPPES UpdateDecember 8, 2015
NPI 1366870206 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License Licensed in ID · PA-1110
Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

6 13TH AVE E, Polson, MT 59860

Accepted Insurance

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Jedidiah Allen Petersen Pa 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 ID3779706551
PECOS Enrollment IDI20151209002109
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.

Hospital Affiliations CMS Care Compare 3

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

St. Patrick Hospital

Acute Care Hospitals · Missoula, MT
5/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number270014
Location500 W BroadwayMissoula, MT 59806 · Missoula County
Emergency services Birthing friendly

St Luke Community Hospital

Critical Access Hospitals · Ronan, MT
OwnershipVoluntary non-profit - Private
CMS Certification Number271325
Location107 6th Ave SWRonan, MT 59864 · Lake County
Emergency services

Providence St Joseph Medical Center

Critical Access Hospitals · Polson, MT
OwnershipVoluntary non-profit - Private
CMS Certification Number271343
Location6 13th Ave EPolson, MT 59860 · Lake County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 59860 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
$87.97 typical visit price
range $56.81 – $172.26
Typical copayment $21.99 (range $14.20 – $43.06)
Most-billed visit code 99203
Established Patient
$70.82 typical visit price
range $18.24 – $140.32
Typical copayment $17.70 (range $4.56 – $35.08)
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.

Referred Medical Equipment & Supplies CMS DME claims 2

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate E1390
DME-Oxygen and Supplies · category DC002N
2 suppliers13 claims13 services$119.34 avg. paid by Medicare
Pharmacy dispensing fee for inhalation drug(s); per 30 days Q0513
DME-Other DME · category DE000N
2 suppliers13 claims13 services$18.03 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 20

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

Pediatrics
6 13TH AVE E
POLSON, MT 59860
Home Health
6 13TH AVE E
POLSON, MT 59860
Surgery
6 13TH AVE E
POLSON, MT 59860
Nurse Anesthetist, Certified Registered
6 13TH AVE E
POLSON, MT 59860
Radiology (Diagnostic Radiology)
6 13TH AVE E
POLSON, MT 59860
Clinic/Center (Medical Specialty)
6 13TH AVE E
POLSON, MT 59860
Family Medicine
6 13TH AVE E
POLSON, MT 59860
Internal Medicine (Hematology & Oncology)
6 13TH AVE E
POLSON, MT 59860

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1366870206, enumerated as an "individual" on October 30, 2013.

The provider is located at 6 13TH AVE E POLSON, MT 59860 and the phone number is (406) 883-5680.

Physician Assistant with taxonomy code 363A00000X.

The provider might be accepting Accepts: Blue Cross and Blue Shield of Montana, Mountain. Please consult your insurance carrier or call the provider to verify.

Jedidiah Petersen is affiliated with: ST. PATRICK HOSPITAL, ST LUKE COMMUNITY HOSPITAL and PROVIDENCE ST JOSEPH MEDICAL CENTER.