Michael Jake Petersen, MD in Seattle, WA

Michael Jake Petersen, MD is a medicare enrolled "Pediatrics - Sports Medicine" physician in Seattle, Washington. His current practice location is 3800 Montlake Blvd, Seattle, Washington. You can reach out to his office (for appointments etc.) via phone at (206) 520-5000.

Michael Jake Petersen is licensed to practice in Washington (license number MD.MD.61679347) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1780248146.

Contact Information

	Michael Jake Petersen, MD
	3800 Montlake Blvd, Seattle, WA 98195-0007
	(206) 520-5000
	Not Available

Map and Direction

Physician's Profile

Full Name	Michael Jake Petersen
Gender	Male
Speciality	Pediatrics - Sports Medicine
Location	3800 Montlake Blvd, Seattle, Washington
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1780248146
Provider Enumeration Date: 04/30/2019
Last Update Date: 04/11/2026

Medicare PECOS Information:

PECOS PAC ID: 4183084775
Enrollment ID: I20240905001256

Medical Identifiers

Medical identifiers for Michael Jake Petersen such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1780248146	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
2080S0010X	Pediatrics - Sports Medicine	MD.MD.61679347 (Washington)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Michael Jake Petersen allows following entities to bill medicare on his behalf.

Entity Name	Regents Of The Univ Of Ca
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1013906973 PECOS PAC ID: 3375456619 Enrollment ID: O20031111000892

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Michael Jake Petersen is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Michael Jake Petersen, MD 2516 Stockton Blvd, Sacramento, CA 95817-2208 Ph: () -	Michael Jake Petersen, MD 3800 Montlake Blvd, Seattle, WA 98195-0007 Ph: (206) 520-5000

Reviews and Comments

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Michael Jake Petersen, MD - Medicare Pediatrics in Seattle, WA