Clark E Petersen, M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

3609501205 Issued in UT

Practice address

1544 W Antelope Dr
Layton, UT 84041-1146

Phone

(801) 773-3339

Fax

(801) 773-6727

NPI assigned

Dec 15, 2005

Last updated

Jul 13, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in UT

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

Specialty

Anesthesiology

Education

Saint Louis University School of Medicine, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Holy Cross Hospital-Davis Hospital, Layton, UT, CCN 460041

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Layton Ambulatory Anesthesia, Inc

  • Anesthesiology Physician
  • Layton, UT
  • NPI 1013950286
  Medicare reassignment NPD

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

• Catholic Health Initiatives Colorado

  dba Holy Cross Hospital - Davis

  • General Acute Care Hospital
  • Layton, UT
  • NPI 1346945839
  Care Compare affiliation

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

{
    "created_epoch": "1134604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1275519894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2551 LEWIS PARK DR",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840105762",
            "telephone_number": "801-299-1215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1544 W ANTELOPE DR",
            "city": "LAYTON",
            "state": "UT",
            "postal_code": "840411146",
            "telephone_number": "801-773-3339",
            "fax_number": "801-773-6727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "CLARK",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-15",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "UT",
            "license": "3609501205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "87057151003",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sheila Gay Perry, CSW
• Stephanie Perry
• Gayla Pesnell, RN
• Peter V Wilson, MD, PLLC (Davis Surgical Associates)
• Darrick Peters, DO
• Julie Petersen
• Morrissa Lynn Petersen, RBT
• Nikita Petersen, LCSW
• Stefanie Petersen
• Abigail Peterson, CSW

• Anesthesiology Physician in Layton, UT
• Providers in Layton, UT by specialty
• Anesthesiology Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.