Jeffry Lynes Peterson, CRNA is a medicare enrolled "Nurse Anesthetist, Certified Registered" in Red Bud, Illinois. He graduated from nursing school in 1997 and has 29 years of diverse experience with area of expertise as Certified Registered Nurse Anesthetist (crna). He is a member of the group practice Memorial Hospital and his current practice location is
10117 Pine Crest Rd, Red Bud, Illinois. You can reach out to his office (for appointments etc.) via phone at
(618) 282-2872.
Jeffry Lynes Peterson is licensed to practice in Kentucky (license number 3002489) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1164569729.
Provider's Profile
| Full Name | Jeffry Lynes Peterson |
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| Gender | Male |
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| Speciality | Certified Registered Nurse Anesthetist (crna) |
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| Experience | 29 Years |
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| Location | 10117 Pine Crest Rd, Red Bud, Illinois |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
Medical Education and Training:
- Jeffry Lynes Peterson graduated from nursing school in 1997
NPI Data:
- NPI Number: 1164569729
- Provider Enumeration Date: 01/31/2007
- Last Update Date: 02/04/2020
Medicare PECOS Information:
- PECOS PAC ID: 8729164397
- Enrollment ID: I20120927000800
Medical Identifiers
Medical identifiers for Jeffry Lynes Peterson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
| 1164569729 | NPI | - | NPPES |
| 7424890700 | Medicaid | KY | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
| 367500000X | Nurse Anesthetist, Certified Registered | 124294 (Missouri) | Secondary |
| 367500000X | Nurse Anesthetist, Certified Registered | 209-000383 (Illinois) | Secondary |
| 367500000X | Nurse Anesthetist, Certified Registered | 3002489 (Kentucky) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
| Memorial Hospital | 5294649372 | 18 |
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. Jeffry Lynes Peterson allows following entities to bill medicare on his behalf.
| Entity Name | Memorial Hospital |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1851390132 PECOS PAC ID: 5294649372 Enrollment ID: O20031113000382 |
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| Entity Name | St Marys Hospital Centralia Illinois |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1770687196 PECOS PAC ID: 6709788920 Enrollment ID: O20040127000118 |
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| Entity Name | Sparta Community Hospital D/b/a Quality Healthcare Clinics |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1114984226 PECOS PAC ID: 6709870462 Enrollment ID: O20040414000594 |
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| Entity Name | Sparta Community Hospital |
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| Entity Type | Part A Provider - Critical Access Hospital |
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| Entity Identifiers | NPI Number: 1548216476 PECOS PAC ID: 3971408295 Enrollment ID: O20071002000435 |
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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. Jeffry Lynes Peterson 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 |
Jeffry Lynes Peterson, CRNA 10117 Pine Crest Rd, Red Bud, IL 62278-4458 Ph: (270) 898-1922 | Jeffry Lynes Peterson, CRNA 10117 Pine Crest Rd, Red Bud, IL 62278-4458 Ph: (618) 282-2872 |
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