JERREKA PETERSON (AGACNP) – Acute Care Nurse Practitioner, NPI 1104415827
Acute Care Nurse Practitioner
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for JERREKA PETERSON (AGACNP)
524 SOUTHPARK BLVD
COLONIAL HEIGHTS, VA 238343609
Phone: (804) 504-7980
Fax: (804) 554-5387
Type: Mailing
5613 BELL ST
NORTH DINWIDDIE, VA 238038933
Phone: (804) 943-2560
Type: Mailing
3600 WOODS WAY
STATE FARM, VA 231600002
Phone: (804) 598-4125
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 3 Open Payments records for all available years, with a total value of $41.
Total Amount is formed as General ($41) + Research ($0) + Ownership ($0) = $41.
Last reported payment date: 2023-03-10 • Largest payer in this snapshot: Lilly USA, LLC ($41).
Total Amount
$41
General + Research + Ownership
Payments
3
Total payment records
General Amount
$41
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-03-10
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Lilly USA, LLC | $41 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2021-12-02
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20211202001251 | I | Nurse Practitioner | VA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99309 | Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes | 626 | 146 | $0 |
| 99310 | Subsequent nursing facility care with high level of medical decision making, per day, if using time, at least 45 minutes | 64 | 42 | $0 |
| 99308 | Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes | 55 | 45 | $0 |
Insurance plans in this area (ZIP 23834)
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