Madeliene Alexandra Peterson

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

12058297-4406 Issued in UT

Practice address

170 N 1100 E
American Fork, UT 84003-2961

Phone

(801) 855-3300

NPI assigned

Oct 18, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Madeliene Alexandra Jacob Former name

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

NPH Anesthesia of Utah LLCGroup PAC ID 9537584313, 91 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• American Fork Hospital Hospital, American Fork, UT, CCN 460023
• Orem Community Hospital Hospital, Orem, UT, CCN 460043

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• NPH Anesthesia of Utah, LLC

  • Anesthesiology Physician
  • Ogden, UT
  • NPI 1366077273
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Ihc Health Services, Inc.

  • General Acute Care Hospital
  • Provo, UT
  • NPI 1114025491
  Care Compare affiliation
• Ihc Health Services, Inc.

  • General Acute Care Hospital
  • Orem, UT
  • NPI 1801903240
  Care Compare affiliation
• Ihc Health Services, Inc.

  • General Acute Care Hospital
  • American Fork, UT
  • NPI 1912014358
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1697587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745884800000",
    "number": "1003698507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2221 LAKESIDE BLVD STE 600",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750824416",
            "telephone_number": "469-505-1652",
            "fax_number": "469-436-3976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 N 1100 E",
            "city": "AMERICAN FORK",
            "state": "UT",
            "postal_code": "840032961",
            "telephone_number": "801-855-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "MADELIENE",
        "middle_name": "ALEXANDRA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-10-18",
        "last_updated": "2025-04-29",
        "certification_date": "2025-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "UT",
            "license": "12058297-3102",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "UT",
            "license": "12058297-4406",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MADELIENE",
            "last_name": "JACOB",
            "middle_name": "ALEXANDRA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Erin P Perez
• Adam Perkins, OTD
• Kathryn-Anne Pertab, MS
• Aaron Jacob Peterson, D.O.
• Lindsay Peterson
• Mark Peterson, DPT
• Matthew Martin Peterson, M.D.
• Natasha Peterson
• Steven Peterson
• Kimberly Ann Pettit, M.D.

• Certified Registered Nurse Anesthetist in American Fork, UT
• Providers in American Fork, UT by specialty
• Certified Registered Nurse Anesthetist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.