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

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: August 02, 2026.

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

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.

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
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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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Michael Jake Petersen Md 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.

Other Providers at the Same Location NPPES 19

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.

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 3 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.