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JACQUELINE R PEDERSON APRN
NPI 1922670926
Nurse Practitioner - Family in Atchison, KS

Active since July 11, 2021PECOS EnrolledAccepts Medicare Assignment
800 RAVENHILL DR STE 100&107, ATCHISON, KS 66002(913) 367-7300(913) 674-2030 Get Directions Write a Review

NPPES record last updated: March 17, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Mar 17, 2026, Jul 11, 2021 (2 updates tracked since 2021).

About Jacqueline R Pederson Aprn NPPES

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

JACQUELINE R PEDERSON APRN (NPI 1922670926) is an individual family provider in Atchison, Kansas, licensed in Kansas (53-80318) and active in the NPI registry since July 2021. She is enrolled in Medicare PECOS, maintains 4 additional practice locations, and is a graduate of Other (2021).

NPPES Registry Identity

NPI1922670926
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameJACQUELINE R PEDERSONCredential: APRN
Location Address800 RAVENHILL DR STE 100&107Atchison, KS 66002-9204
Mailing Address800 Ravenhill DrAtchison, KS 66002-9204 · (913) 367-2131 · Fax (913) 674-2023
Phone(913) 367-7300
Fax(913) 674-2030
Sole ProprietorNo
Medical School CMSOtherGraduated 2021
Enumeration DateJuly 11, 2021
Last NPPES UpdateMarch 17, 20262 updates tracked since enumeration
NPPES CertifiedMarch 17, 2026
✔ NPI 1922670926 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in KS · 53-80318
800 RAVENHILL DR STE 100&107, Atchison, KS 66002
Open in Google Maps ↗

Secondary Practice Locations 4

Location 11903 Euclid AveHorton, KS 66439-1238 · Phone (785) 486-2468 · Fax (785) 486-2371
Location 2311 W Locust StTroy, KS 66087-5252 · Phone (785) 985-3504 · Fax (785) 985-3813
Location 31004 Progress Dr Ste 180&145Lansing, KS 66043-6326 · Phone (913) 297-3215 · Fax (913) 297-2732
Location 4801 Atchison StAtchison, KS 66002-2352 · Phone (913) 367-5020 · Fax (913) 367-1089

Other Identifiers 3

Other016289096KS · Ptan
Medicaid30004760070001KS
Medicaid420100370MO

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Sunflower Health Plan, Ambetter Health, Ambetter Health of Delaware and more.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jacqueline R Pederson Aprn 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 ID4789089293
PECOS Enrollment IDI20210823000238
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 Jacqueline Pederson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Amberwell Atchison Association
Same address
Family Medicine
800 RAVENHILL DR
Atchison, KS 66002
  • Reassigned Medicare billing, Kansas enrollment
  • Also billed through NPI 1932151487 (Kansas)
  • 78 clinicians in this Medicare group
NPI 1528450913 (913) 367-2131

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

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 66002 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
$81.98 typical visit price
range $53.00 – $161.67
Typical copayment $20.49 (range $13.25 – $40.41)
Most-billed visit code 99203
Established Patient
$94.12 typical visit price
range $16.88 – $132.11
Typical copayment $23.53 (range $4.22 – $33.02)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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.

MRS. LEXY JADE ROONEY PA-C
Physician Assistant
800 RAVENHILL DR STE 100&107
ATCHISON, KS 66002
Atchison County (913) 367-7300
ABBY GENTRY FNP-C
Nurse Practitioner (Family)
800 RAVENHILL DR STE 100&107
ATCHISON, KS 66002
Atchison County (913) 367-2131
JOHN READ EPLEE M.D.
Family Medicine
800 RAVENHILL DR STE 100&107
ATCHISON, KS 66002
Atchison County (913) 367-7300
JAYMI KEARNEY
Nurse Practitioner (Family)
800 RAVENHILL DR STE 100&107
ATCHISON, KS 66002
Atchison County (913) 367-7300
CASSANDRA D. VILANDER APRN
Nurse Practitioner
800 RAVENHILL DR STE 100&107
ATCHISON, KS 66002
Atchison County (913) 367-7300
MICHELLE J PRUESSNER PA-C
Physician Assistant
800 RAVENHILL DR STE 100&107
ATCHISON, KS 66002
Atchison County (913) 367-2131
BONNIE A TACKETT MD
Family Medicine
800 RAVENHILL DR STE 100&107
ATCHISON, KS 66002
Atchison County (913) 367-6688
MRS. MICHAELA ELIZABETH RZIHA PA
Physician Assistant
800 RAVENHILL DR STE 100&107
ATCHISON, KS 66002
Atchison County (913) 367-7300

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 Jacqueline Pederson's NPI number?

The NPI number for Jacqueline Pederson is 1922670926. It was assigned to this individual provider in the NPPES registry on July 11, 2021.

Where is Jacqueline Pederson located?

Jacqueline Pederson practices at 800 Ravenhill Dr Ste 100&107, Atchison, KS 66002. The listed phone number is (913) 367-7300.

What is Jacqueline Pederson's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Jacqueline Pederson enrolled in Medicare?

Yes. Jacqueline Pederson is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Jacqueline Pederson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jacqueline Pederson reassigns Medicare benefits to Amberwell Atchison Association (Atchison, 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 Jacqueline Pederson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Jacqueline Pederson accept?

Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from Sunflower Health Plan, Ambetter of Oklahoma and Blue Cross and Blue Shield of Kansas City and 2 other insurers list Jacqueline Pederson 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 Jacqueline Pederson was last updated on March 17, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.