JASON PETUSEVSKY DO
NPI 1457987133
Student in an Organized Health Care Education/Training Program in Sacramento, CA

Q: What is Jason Petusevsky's NPI number?

The NPI number for Jason Petusevsky is 1457987133. It was assigned to this individual provider in the NPPES registry on March 13, 2020.

Q: What is Jason Petusevsky's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Jason Petusevsky was last updated on April 23, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since March 13, 2020PECOS Enrolled

4860 Y ST, SACRAMENTO, CA 95817(954) 591-5873 Get Directions Write a Review

NPPES record last updated: April 23, 2026. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Apr 23, 2026, Feb 15, 2025, Mar 13, 2020 (3 updates tracked since 2020).

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About Jason Petusevsky Do NPPES

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

JASON PETUSEVSKY DO (NPI 1457987133) is an individual student in an organized health care education/training program in Sacramento, California and active in the NPI registry since March 2020. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1457987133

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameJASON PETUSEVSKYCredential: DO

Location Address4860 Y STSacramento, CA 95817-2307

Mailing Address5300 F StSacramento, CA 95819-3203 · (954) 591-5873

Phone(954) 591-5873

Sole ProprietorYes

Enumeration DateMarch 13, 2020

Last NPPES UpdateApril 23, 20263 updates tracked since enumeration

NPPES CertifiedApril 23, 2026

✔ NPI 1457987133 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

4860 Y ST, Sacramento, CA 95817

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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jason Petusevsky Do is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

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