1. Home
  2. Directory
  3. Kansas
  4. Topeka
  5. Specialist
  6. NPI Profile

DR. JACK T PETERSON JR. MD
NPI 1508860487
Specialist in Topeka, KS

Active since June 09, 2005PECOS Enrolled
631 SW HORNE ST, STE 400, TOPEKA, KS 66606(785) 234-9000(785) 234-9119 Get Directions Write a Review

NPPES record last updated: April 24, 2012. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Dr. Jack T Peterson Jr. Md NPPES

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

DR. JACK T PETERSON JR. MD (NPI 1508860487) is an individual specialist in Topeka, Kansas, licensed in Kansas (0422259) and active in the NPI registry since June 2005. He is enrolled in Medicare PECOS and is a graduate of Baylor College Of Medicine (1983).

NPPES Registry Identity

NPI1508860487
Entity TypeIndividualMale
Primary Taxonomy174400000X
Provider Legal NameDR. JACK T PETERSON JR.Credential: MD
Location Address631 SW HORNE ST, STE 400Topeka, KS 66606-1661
Mailing Address631 Sw Horne St, Ste 400Topeka, KS 66606-1661 · (785) 234-9000 · Fax (785) 234-9119
Phone(785) 234-9000
Fax(785) 234-9119
Sole ProprietorYes
Medical School CMSBaylor College Of MedicineGraduated 1983
Enumeration DateJune 9, 2005
Last NPPES UpdateApril 24, 2012
✔ NPI 1508860487 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in KS · 0422259
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
631 SW HORNE ST, Topeka, KS 66606
Open in Google Maps ↗

Other Identifiers 7

Other240007246KS · Railroad Medicare
Medicare ID-Type Unspecified100516KS · Medicare For Dr. Peterson
Other481191346KS · Tax Id
Medicaid100144860BKS
Medicare UPIND09155KS
Other628770KS · First Guard
Other100516KS · Blue Cross

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Jack T Peterson Jr. Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID5890838759
PECOS Enrollment IDI20100202000029
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 Reassignment

Medicare enrollment records show Jack Peterson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Center For Plastic Surgery, PA
Same address
Plastic and Reconstructive Surgery
631 SW HORNE ST, SUITE 400
Topeka, KS 66606
  • Reassigned Medicare billing, Kansas enrollment
NPI 1457689770 (785) 234-9000

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

Other Providers at the Same Location NPPES 15

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

IM/ID MEDICAL CONSULTANTS
Internal Medicine (Endocrinology, Diabetes & Metabolism)
631 SW HORNE ST, SUITE 420
TOPEKA, KS 66606
Shawnee County (785) 234-8405
PARTNERS IN PEDIATRICS PA
Pediatrics (Adolescent Medicine)
631 SW HORNE ST, SUITE 340
TOPEKA, KS 66606
Shawnee County (785) 234-4624
RUPP UROLOGY LLC
Urology
631 SW HORNE ST, SUITE 150
TOPEKA, KS 66606
Shawnee County (785) 354-7877
SARAH ORBITA DAVIS
Nurse Practitioner (Family)
631 SW HORNE ST
TOPEKA, KS 66606
Shawnee County (785) 295-7962
TOPEKA NEUROLOGY ASSOCIATES, P.A.
Psychiatry & Neurology (Neurology)
631 SW HORNE ST, SUITE 200
TOPEKA, KS 66606
Shawnee County (785) 234-6300
CENTER FOR PLASTIC SURGERY, PA
Surgery (Plastic and Reconstructive Surgery)
631 SW HORNE ST, SUITE 400
TOPEKA, KS 66606
Shawnee County (785) 234-9000
WADE B WELCH M.D.
Psychiatry & Neurology (Neurology)
631 SW HORNE ST, STE 420
TOPEKA, KS 66606
Shawnee County (785) 295-7878
KATIE WOHLGEMUTH APRN
Nurse Practitioner
631 SW HORNE ST
TOPEKA, KS 66606
Shawnee County (785) 270-5000

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 Jack Peterson's NPI number?

The NPI number for Jack Peterson is 1508860487. It was assigned to this individual provider in the NPPES registry on June 9, 2005.

Where is Jack Peterson located?

Jack Peterson practices at 631 SW Horne St Ste 400, Topeka, KS 66606. The listed phone number is (785) 234-9000.

What is Jack Peterson's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Is Jack Peterson enrolled in Medicare?

Yes. Jack Peterson is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Jack Peterson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jack Peterson reassigns Medicare benefits to Center For Plastic Surgery, PA (Topeka, KS). The 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 Jack Peterson'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 Jack Peterson was last updated on April 24, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.