MICHAEL JAKE PETERSEN MD
NPI 1780248146
Pediatrics - Sports Medicine in Seattle, WA

Q: What is Michael Petersen's NPI number?

The NPI number for Michael Petersen is 1780248146. It was assigned to this individual provider in the NPPES registry on April 30, 2019.

Q: What is Michael Petersen's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Sports Medicine, with taxonomy code 2080S0010X.

Q: When was this NPI record last updated?

The NPPES record for Michael Petersen was last updated on April 11, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.

Active since April 30, 2019PECOS Enrolled

3800 MONTLAKE BLVD, SEATTLE, WA 98195(206) 520-5000 Get Directions Write a Review

NPPES record last updated: April 11, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Apr 11, 2026, Jun 26, 2024, Mar 24, 2021 and 1 more (4 updates tracked since 2019).

On this page

About Michael Jake Petersen Md NPPES

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

MICHAEL JAKE PETERSEN MD (NPI 1780248146) is an individual sports medicine provider in Seattle, Washington, licensed in Washington (MD.MD.61679347) and active in the NPI registry since April 2019. He is enrolled in Medicare PECOS and is a graduate of Rush Medical College Of Rush University (2021).

NPPES Registry Identity

NPI1780248146

Entity TypeIndividualMale

Primary Taxonomy2080S0010X

Provider Legal NameMICHAEL JAKE PETERSENCredential: MD

Location Address3800 MONTLAKE BLVDSeattle, WA 98195-0007

Mailing Address2516 Stockton BlvdSacramento, CA 95817-2208

Phone(206) 520-5000

Sole ProprietorYes

Medical School CMSRush Medical College Of Rush UniversityGraduated 2021

Enumeration DateApril 30, 2019

Last NPPES UpdateApril 11, 20264 updates tracked since enumeration

NPPES CertifiedApril 11, 2026

✔ NPI 1780248146 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatrics · Sports MedicineAllopathic & Osteopathic Physicians

Taxonomy Code2080S0010X

License✔ Licensed in WA · MD.MD.61679347

Definition

A pediatrician who is responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the healthcare of the individual engaged in physical exercise (sports) whether as an individual or in team participation.

3800 MONTLAKE BLVD, Seattle, WA 98195

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Michael Jake Petersen Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID4183084775

PECOS Enrollment IDI20260618004380

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

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

The Association Of Chrmc And University Physicians

1.1 mi

Pediatrics

4500 SAND POINT WAY NE
Seattle, WA 98105

Reassigned Medicare billing, Washington enrollment
1,443 clinicians in this Medicare group

NPI 1255449963 (206) 987-8450

The Association Of University Physicians

3.4 mi

Anesthesiology

701 5TH AVE, SUITE 700
Seattle, WA 98104

Reassigned Medicare billing, Washington enrollment
4,364 clinicians in this Medicare group

NPI 1023041159 (206) 543-6420

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 18

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

ELLIOT J O'CONNOR DPT

Physical Therapist

3800 MONTLAKE BLVD
SEATTLE, WA 98195

King County (877) 520-5000

UNIVERSITY OF WASHINGTON MEDICAL CENTER

Clinic/Center (Physical Therapy)

3800 MONTLAKE BLVD
SEATTLE, WA 98195

King County (206) 598-1534

MAHRA K. DAVIDSON PA

Physician Assistant (Surgical)

3800 MONTLAKE BLVD
SEATTLE, WA 98195

King County (062) 520-5000

DR. CHRISTOPHER Y. KWEON MD

Orthopaedic Surgery

3800 MONTLAKE BLVD
SEATTLE, WA 98195

King County (206) 598-1534

BRUCE C TWADDLE MD

Orthopaedic Surgery (Sports Medicine)

3800 MONTLAKE BLVD, ROOM 148B
SEATTLE, WA 98195

King County (206) 543-1552

CRISTINA GETTO

Specialist/Technologist (Athletic Trainer)

3800 MONTLAKE BLVD
SEATTLE, WA 98195

King County (206) 221-6276

JOSHUA GELLERT DPT

Physical Therapist

3800 MONTLAKE BLVD
SEATTLE, WA 98195

King County (206) 520-5000

STEPHEN C. JOHNSON MD

Physical Medicine & Rehabilitation (Sports Medicine)

3800 MONTLAKE BLVD
SEATTLE, WA 98195

King County (206) 598-1534

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 Michael Petersen's NPI number?

The NPI number for Michael Petersen is 1780248146. It was assigned to this individual provider in the NPPES registry on April 30, 2019.

Where is Michael Petersen located?

Michael Petersen practices at 3800 Montlake Blvd, Seattle, WA 98195. The listed phone number is (206) 520-5000.

What is Michael Petersen's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Sports Medicine, with taxonomy code 2080S0010X.

Is Michael Petersen enrolled in Medicare?

Yes. Michael Petersen is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Michael Petersen's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Michael Petersen reassigns Medicare benefits to 2 organizations: The Association Of Chrmc And University Physicians (Seattle, WA) and The Association Of University Physicians (Seattle, WA). 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 Michael Petersen's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Michael Petersen accept?

Health plans from Ambetter Health list Michael Petersen as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Michael Petersen was last updated on April 11, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.