NPIMap

Individual provider Active NPI

Michael Peterson, MD

  • Diagnostic Radiology Physician
  • Salt Lake City, UT
National Provider Identifier
1184121675
Registry record updated Jun 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
11421570-1205 Issued in UT
Practice address
30 N 1900 E RM 1A071
Salt Lake City, UT 84132-2140
Phone
(801) 581-2868
NPI assigned
Apr 10, 2018
Last updated
Jun 14, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 11421570-1205 UT Primary

Addresses

Primary practice location

30 N 1900 E RM 1A071
Salt Lake City, UT 84132-2140

Mailing address

30 N 1900 E RM 1A071
Salt Lake City, UT 84132-2140
Phone (801) 581-2868

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mpeterson352191@direct.med.utah.edu Direct University of Utah

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT, WA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230519002353 UT Practitioner - Diagnostic Radiology 2769815505 Reassigns benefits to 3 organizations
I20260320001446 WA Practitioner - Diagnostic Radiology 2769815505 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Duke University School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tellica Imaging - Washington LLCGroup PAC ID 0648757393, 50 clinicians
Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Practice addresses (Care Compare)

2941 S 38TH St
Suite E
Tacoma, WA 98409-5647
Phone (253) 534-8689

5121 S Cottonwood St
Murray, UT 84107-5701
Phone (801) 507-7000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.77 of 100Reported as group
Quality
91.47
Promoting interoperability
100
Improvement activities
40
Cost
74.42

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11421570-1205UTMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services, Inc. CurrentSince Jul 20, 2024 Accepting new patients
University of Utah Adult Services Current Accepting new patients
Tellica Imaging, LLC CurrentSince Jul 1, 2024 Accepting new patients
Tellica Imaging, LLC CurrentSince Jul 1, 2024 Accepting new patients
Tellica Imaging, LLC CurrentSince Sep 5, 2024 Accepting new patients
University of Utah Adult Services Diagnostic Radiology CurrentSince May 1, 2023 Accepting new patients
Ihc Health Services Inc Current Accepting new patients
Tellica Imaging, LLC CurrentSince Jul 1, 2024 Accepting new patients
Tellica Imaging, LLC Diagnostic Radiology CurrentSince Sep 5, 2024 Accepting new patients
University of Utah Adult Services CurrentSince May 1, 2023 Accepting new patients
Ihc Health Services Inc CurrentSince Jul 20, 2024 Accepting new patients

Locations

127 S 500 E
Ste 400B
Salt Lake City, UT 84102
Phone (801) 587-6478

5217 S State St
Ste 200
Salt Lake City, UT 84107
Phone (208) 417-5100

36 S Street St
Ste 2200
Salt Lake Cty, UT 84111
Phone (385) 622-0669

5121 S Cottonwood St
Salt Lake Cty, UT 84107
Phone (801) 408-8998

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

1380 E Medical Center Dr
St George, UT 84790
Phone (435) 251-2992

1380 E Medical Center Dr
#P
St George, UT 84790
Phone (435) 251-2355

Interoperability endpoints

  • Direct secure messaging: mpeterson352191@direct.med.utah.edu

Organizations & group practices 12

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

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1523318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686700800000",
    "number": "1184121675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 N 1900 E RM 1A071",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841322140",
            "telephone_number": "801-581-2868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 N 1900 E RM 1A071",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841322140",
            "telephone_number": "801-581-2868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-10",
        "last_updated": "2023-06-14",
        "certification_date": "2023-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "UT",
            "license": "11421570-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mpeterson352191@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.