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

Jeffry Lynes Peterson, CRNA

Individual provider Certified Registered Nurse Anesthetist · NPI 1164569729

Jeffry Lynes Peterson, CRNA is a Certified Registered Nurse Anesthetist (CRNA) in Red Bud, Illinois. Qualified in 1997, 29 years ago. Practices with Memorial Hospital, a 30-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Illinois, Kentucky and Missouri.

Years since qualifying
29
Licensed in
IL, KY, MO
In the registry since
2007
Specialties on file
3
What do these letters mean?
CRNA — Certified Registered Nurse Anesthetist
An advanced practice nurse who administers anaesthesia.

See every abbreviation used in this directory →

Practice location Address checks out

10117 Pine Crest Rd
Red Bud, IL 62278-4458
Phone: (618) 282-2872
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 818 E Broadway St, Sparta, IL 62286-1820 — (618) 443-2177

Specialties & licences

Certified Registered Nurse Anesthetist (primary) Taxonomy 367500000X · Licence 3002489 (KY)
Certified Registered Nurse Anesthetist Taxonomy 367500000X · Licence 124294 (MO)
Certified Registered Nurse Anesthetist Taxonomy 367500000X · Licence 209-000383 (IL)

Record details

NPI number1164569729
Entity typeIndividual (Type 1)
GenderMale
Credentials CRNA
Sole proprietorNo
NPI enumeratedJanuary 31, 2007
Last updated in NPPESMay 29, 2026
Certification dateMay 29, 2026

Medicare enrollment

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

Medicare specialtyCERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
Medical schoolOTHER
Graduated 1997 (29 years in practice)
Group practice Memorial Hospital — 30 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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