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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

JORDAN PETERSEN
NPI 1992382097
Student in an Organized Health Care Education/Training Program in Columbus, OH

Active since March 25, 2021PECOS Enrolled
395 W 12TH AVE FL 3, COLUMBUS, OH 43210(614) 293-3989(614) 293-9789 Get Directions Write a Review

NPPES record last updated: October 16, 2026. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Oct 16, 2026, Mar 25, 2021 (2 updates tracked since 2021).

About Jordan Petersen NPPES

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

JORDAN PETERSEN (NPI 1992382097) is an individual student in an organized health care education/training program in Columbus, Ohio and active in the NPI registry since March 2021. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1992382097
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameJORDAN PETERSEN
Location Address395 W 12TH AVE FL 3Columbus, OH 43210-1267
Mailing Address395 W 12th Ave Fl 3Columbus, OH 43210-1267
Phone(614) 293-3989
Fax(614) 293-9789
Sole ProprietorNo
Enumeration DateMarch 25, 2021
Last NPPES UpdateOctober 16, 20262 updates tracked since enumeration
NPPES CertifiedOctober 16, 2026
✔ NPI 1992382097 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
395 W 12TH AVE FL 3, Columbus, OH 43210
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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)

Jordan Petersen 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 20

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

CODY NICHOLAS JUSTICE
Student in an Organized Health Care Education/Training Program
395 W 12TH AVE FL 3
COLUMBUS, OH 43210
Franklin County (614) 293-3989
TANVI BAFNA MD, MPH
Student in an Organized Health Care Education/Training Program
395 W 12TH AVE FL 3
COLUMBUS, OH 43210
Franklin County (614) 293-3989
MR. WILLIAM JOHN PELLEGRINO
Student in an Organized Health Care Education/Training Program
395 W 12TH AVE FL 3
COLUMBUS, OH 43210
Franklin County (614) 293-3989
KAMEL AOUN
Student in an Organized Health Care Education/Training Program
395 W 12TH AVE FL 3
COLUMBUS, OH 43210
Franklin County (614) 293-3989
DR. ANTHONY MANSOUR
Student in an Organized Health Care Education/Training Program
395 W 12TH AVE FL 3
COLUMBUS, OH 43210
Franklin County (614) 293-3989
NICOLE VARDA MD
Student in an Organized Health Care Education/Training Program
395 W 12TH AVE FL 3
COLUMBUS, OH 43210
Franklin County (614) 293-3989
CLIFFORD WILFRED UKARAJIT
Student in an Organized Health Care Education/Training Program
395 W 12TH AVE FL 3
COLUMBUS, OH 43210
Franklin County (614) 293-3989
NICOLE DANIELLE HESS MD
Student in an Organized Health Care Education/Training Program
395 W 12TH AVE FL 3
COLUMBUS, OH 43210
Franklin County (614) 293-3989

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 Jordan Petersen's NPI number?

The NPI number for Jordan Petersen is 1992382097. It was assigned to this individual provider in the NPPES registry on March 25, 2021.

Where is Jordan Petersen located?

Jordan Petersen practices at 395 W 12th Ave Fl 3, Columbus, OH 43210. The listed phone number is (614) 293-3989.

What is Jordan Petersen's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Jordan Petersen enrolled in Medicare?

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

When was this NPI record last updated?

The NPPES record for Jordan Petersen was last updated on October 16, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 days 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.