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Active NPI 1164580429 Individual Practitioner Male Practitioner

John J Petersen , PA

Physician Assistant - Surgical • Medford, OR

Professional Overview & Biography Verified Profile Summary

John Petersen, PA is a registered healthcare professional specializing in Physician Assistant - Surgical in Medford, OR. Practice services are available at 520 MEDICAL CENTER DR under active NPI credentials.

Frequently performed procedures and clinical services include harvest of veins for coronary artery bypass procedure using an endoscope, coronary artery bypass using artery graft, 1 graft. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

520 Medical Center Dr
Suite 201

Medford, OR 975044334

Telephone 5417895710
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Physician Assistant - Surgical in Medford, OR

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.7 Yrs
State Avg: 13.7 Yrs
Regional Practice Density
29 Specialists

Practicing in Medford, OR (368 Statewide)

Telehealth Adoption Rate
10.3% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
66.6% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2019)
Reporting Year:
HCPCS Code & Description Services Patients Submitted Charge Medicare Allowed
33508 Harvest of veins for coronary artery bypass procedure using an endoscope
19 19 $5.85 $2.08
33533 Coronary artery bypass using artery graft, 1 graft
18 18 $677.54 $226.46

Medical Specialties & State Licenses

Physician Assistant - Surgical Primary Specialty

NUCC Taxonomy Code: 363AS0400X

State License OR PA00228

Definition to come...

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
500613512 (OR)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

10 Associated Practitioners
Daniel Neville

Physician Assistant - Surgical

NPI 1033588546
Dr. Oscar Sanchez , MD

Psychiatry & Neurology - Neurology

NPI 1063412427

Doctor of Medicine (M.D.)

Kathryn Hardaway , NP-C

Nurse Practitioner - Family

NPI 1073079430

Nurse Practitioner (Certified)

Dr. Dani Thomas , DO

Internal Medicine - Critical Care Medicine

NPI 1104056092

Doctor of Osteopathic Medicine (D.O.)

Eileen Stiles , NP

Nurse Practitioner - Adult Health

NPI 1114997244

Nurse Practitioner

Dr. David Folsom , MD

Thoracic Surgery (Cardiothoracic Vascular Surgery)

NPI 1417005729

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active January 16, 2013

NPI status registered as active in NPPES database

📍
Updated Practice Location January 16, 2013

Registered at 520 MEDICAL CENTER DR, SUITE 201, MEDFORD, OR 975044334 (Tel: 5417895710)

📍
Updated Business Mailing Address January 16, 2013

Registered at 2620 E BARNETT RD, SUITE H, MEDFORD, OR 975048344 (Tel: 5417895250)

👤
Provider Name / Credentials Updated January 16, 2013

Recorded as JOHN PETERSEN, PA

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) January 16, 2013

Physician Assistant (License #PA00228 in OR)

🟢
Initial NPI Registration & Enumeration December 05, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1164580429
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: December 05, 2006
Last Update: January 16, 2013
Sole Proprietor: No

Mailing Address

2620 E Barnett Rd, Suite H

Medford, OR 975048344

Phone: 5417895250

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.