Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Peter Shi, DO

Individual provider Internal Medicine Physician · NPI 1336569904

Dr. Peter Shi, DO is an Internal Medicine in Jackson, Tennessee. Graduated from New York College of Osteo Medicine of New York Institute of Technology in 2014, 12 years ago. Practices with Sebastian Physician Services, PLLC, a 41-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Indiana and Tennessee.

Years since qualifying
12
Trained at
New York College of Osteo Medicine of New York Institute of Technology
Licensed in
IN, TN
In the registry since
2014
Specialties on file
2
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

620 Skyline Dr
Jackson, TN 38301-3923
Phone: (731) 541-4923
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 11109 Parkview Plaza Dr, Fort Wayne, IN 46845-1701 — (260) 266-2020

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X · Licence 02005562A (IN)
Internal Medicine Physician Taxonomy 207R00000X · Licence 3196 (TN)

Record details

NPI number1336569904
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorNo
NPI enumeratedApril 22, 2014
Last updated in NPPESOctober 15, 2022
Certification dateOctober 15, 2022
Mailing address1804 Highway 45 Byp Ste 604, Jackson, TN 38305-4403

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyINTERNAL MEDICINE
Medical schoolNEW YORK COLLEGE OF OSTEO MEDICINE OF NEW YORK INSTITUTE OF TECHNOLOGY
Graduated 2014 (12 years in practice)
Group practice Sebastian Physician Services, Pllc — 41 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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