JONATHAN DALE PECKHAM
NPI 1992130884
Student in an Organized Health Care Education/Training Program in Phoenix, AZ
About Jonathan Dale Peckham NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JONATHAN DALE PECKHAM (NPI 1992130884) is an individual student in an organized health care education/training program in Phoenix, Arizona and active in the NPI registry since September 2013. He is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Jonathan Dale Peckham is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
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.
PHOENIX, AZ 85008
PHOENIX, AZ 85008
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 Jonathan Peckham's NPI number?
The NPI number for Jonathan Peckham is 1992130884. It was assigned to this individual provider in the NPPES registry on September 10, 2013.
Where is Jonathan Peckham located?
Jonathan Peckham practices at 2601 E Roosevelt St, Phoenix, AZ 85008. The listed phone number is (602) 344-5445.
What is Jonathan Peckham's specialty?
The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.
Is Jonathan Peckham enrolled in Medicare?
Yes. Jonathan Peckham is registered in the Medicare PECOS enrollment system.
When was this NPI record last updated?
The NPPES record for Jonathan Peckham was last updated on April 1, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.
# Jonathan Dale Peckham · NPI 1992130884
Student in an Organized Health Care Education/Training Program provider in Phoenix, Arizona. Individual provider, active in the CMS NPPES registry since September 10, 2013.
## Identity
- **NPI:** 1992130884 (Entity type: Individual)
- **Enumerated:** September 10, 2013
- **Primary specialty:** Student in an Organized Health Care Education/Training Program · taxonomy 390200000X
- **Sole proprietor:** Yes
## Practice location
- **Address:** 2601 E ROOSEVELT ST, Phoenix, AZ 85008-4973
- **Phone:** (602) 344-5445
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
## Record status
- **NPPES last updated:** April 1, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1992130884) · Data from the CMS NPPES public registry.