Individual provider Active NPI

Peter Utas, M.D.

  • Emergency Medicine Physician
  • Glendale, CA
National Provider Identifier
1083661284
Registry record updated Nov 14, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
G37712 Issued in CA
Practice address
1509 Wilson Ter
Emergency Department
Glendale, CA 91206-4007
Phone
(818) 409-8000
NPI assigned
May 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X G37712 CA Primary

Addresses

Primary practice location

1509 Wilson Ter
Emergency Department
Glendale, CA 91206-4007

Mailing address

4551 Glencoe Ave
Suite 260
Marina del Rey, CA 90292-6385
Phone (310) 301-2030

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110225000290 CA Practitioner - Emergency Medicine 5799966693 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G37712CAMDEmergency Medicine Physician
37712CAMDRegistered Respiratory Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Parker Valley Emergency Physicians Medical Group Inc Emergency Medicine CurrentSince Jan 1, 2011 Accepting new patients

Locations

1509 Wilson Ter
Glendale, CA 91206
Phone (818) 409-8071

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194998400000",
    "number": "1083661284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4551 GLENCOE AVE",
            "address_2": "SUITE 260",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902926385",
            "telephone_number": "310-301-2030",
            "fax_number": "310-306-5247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1509 WILSON TER",
            "address_2": "EMERGENCY DEPARTMENT",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912064007",
            "telephone_number": "818-409-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UTAS",
        "first_name": "PETER",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-31",
        "last_updated": "2007-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "G37712",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, CA

Sources for this page

Verify at the official NPI Registry.