NPIMap

Individual provider Active NPI

Charles Matthew Peterson, MD

  • Reproductive Endocrinology Physician
  • Salt Lake City, UT
National Provider Identifier
1316037930
Registry record updated Dec 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Reproductive Endocrinology PhysicianTaxonomy code 207VE0102X
License
172719-1205 Issued in UT
Practice address
30 N 1900 E
Suite 2B200
Salt Lake City, UT 84132-0002
Phone
(801) 587-3834
NPI assigned
Oct 13, 2006
Last updated
Dec 1, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Reproductive Endocrinology Physician 207VE0102X 172719-1205 UT Primary

Addresses

Primary practice location

30 N 1900 E
Suite 2B200
Salt Lake City, UT 84132-0002

Mailing address

30 N 1900 E
Suite 2B200
Salt Lake City, UT 84132-0002
Phone (801) 587-3834

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mpeterson2305@direct.med.utah.edu Direct UNIVERSITY OF UTAH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031203000713 UT Practitioner - Obstetrics/Gynecology 0143125096 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
172719-1205UTMDReproductive Endocrinology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Specialty Services Current Accepting new patients
University of Utah Adult Services Current Accepting new patients
University of Utah Specialty Services CurrentSince Feb 1, 2015 Accepting new patients
University of Utah Adult Services CurrentSince Apr 1, 2015 Accepting new patients
University of Utah Adult Services CurrentSince Apr 1, 2015 Accepting new patients
University of Utah Specialty Services CurrentSince Feb 1, 2015 Accepting new patients
Utah Fertility Center Past Accepting new patients
University of Utah Department of OB-GYN Past Accepting new patients
University of Utah Hospital Professional Services Past Accepting new patients

Locations

50 N Medical Dr
#U
Salt Lake Cty, UT 84132
Phone (801) 581-4314

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

555 Foothill Dr
Slc, UT 84112
Phone (801) 581-7589

Interoperability endpoints

  • Direct secure messaging: mpeterson2305@direct.med.utah.edu

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638316800000",
    "number": "1316037930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 N 1900 E",
            "address_2": "SUITE 2B200",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841320002",
            "telephone_number": "801-587-3834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 N 1900 E",
            "address_2": "SUITE 2B200",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841320002",
            "telephone_number": "801-587-3834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "CHARLES",
        "middle_name": "MATTHEW",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-13",
        "last_updated": "2021-12-01",
        "certification_date": "2021-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VE0102X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Reproductive Endocrinology",
            "state": "UT",
            "license": "172719-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mpeterson2305@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.