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

Individual provider Physician Assistant · NPI 1366870206

Jedidiah Allen Petersen, PA is a Physician Assistant in Polson, Montana. Qualified in 2013, 13 years ago. Practices with Providence St Joseph Medical Center, a 52-clinician group and accepts Medicare assignment. Licensed in Idaho.

Years since qualifying
13
Licensed in
ID
In the registry since
2013
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

6 13th Ave E
Polson, MT 59860-5315
Phone: (406) 883-5680
Fax: (406) 883-8960
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA-1110 (ID)

Record details

NPI number1366870206
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedOctober 30, 2013
Last updated in NPPESDecember 8, 2015

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2013 (13 years in practice)
Group practice Providence St Joseph Medical Center — 52 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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