Active NPI
Kelsea Michelle Peterson, PA-C
- Physician Assistant
- Salt Lake City, UT
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 11293178-1206
- Practice address
- 100 N Mario Capecchi Dr
Salt Lake City, UT 84113-1103 - Phone
- (801) 662-1070
- NPI assigned
- Nov 27, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 11293178-1206 | UT | Primary |
Addresses
Primary practice location
100 N Mario Capecchi Dr
Salt Lake City, UT 84113-1103
Mailing address
PO Box 30180
Salt Lake City, UT 84130-0180
Other names 1
- Kelsea Michelle Struski
Medicare participation
Medicare enrollment files- 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: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ihc Health Services, Inc. | Current | Accepting new patients | |
| Ihc Health Services Inc | Physician Assistant | Current | Accepting new patients |
Locations
100 N Mario Capecchi Dr
Slc, UT 84113
Phone (801) 587-7109
1380 E Medical Center Dr
#P
St George, UT 84790
Phone (435) 251-2355
1380 E Medical Center Dr
St George, UT 84790
Phone (435) 251-2992
Organizations & group practices 3
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.
-
dba IMED Physicians Billing
- Multi-Specialty Clinic/Center
- Murray, UT
- NPI 1629260880
-
dba Spanish Fork Hospital Physicians
- Multi-Specialty Clinic/Center
- Spanish Fork, UT
- NPI 1326669789
Physician Assistant
-
dba St George Adolescent Partial Hospitalization
- Psychiatry Physician
- St George, UT
- NPI 1023843844
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1543276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678752000000",
"number": "1306316849",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 30180",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841300180"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 N MARIO CAPECCHI DR",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841131103",
"telephone_number": "801-662-1070"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "KELSEA",
"middle_name": "MICHELLE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-11-27",
"last_updated": "2023-03-14",
"certification_date": "2022-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "UT",
"license": "11293178-1206",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KELSEA",
"last_name": "STRUSKI",
"middle_name": "MICHELLE",
"credential": "PA-C",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2023; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.