Johnathon Ivar Pedersen, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

10222638-4405 Issued in UT

Practice address

230 S Main St
Bountiful, UT 84010-6236

Phone

(801) 698-0544

NPI assigned

Dec 5, 2024

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science, Nurse Practitioner

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 and National Provider Directory roles.

• Valdar LLC

  • Family Nurse Practitioner
  • Bountiful, UT
  • NPI 1336619675

  Family, UT

  Medicare reassignment NPD
• Option Care Infusion Suites, LLC

  • Nurse Practitioner
  • Murray, UT
  • NPI 1164194601
  NPD
• Top Medical Now LLC

  • Family Medicine Physician
  • Bountiful, UT
  • NPI 1982308425
  NPD
• Option Care Infusion Suites, LLC

  • Infusion Therapy Clinic/Center
  • Memphis, TN
  • NPI 1497584445
  NPD

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

{
    "created_epoch": "1733356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742083200000",
    "number": "1346056348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 S MAIN ST",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840106236",
            "telephone_number": "801-698-0544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 S MAIN ST",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840106236",
            "telephone_number": "801-698-0544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSEN",
        "first_name": "JOHNATHON",
        "middle_name": "IVAR",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-12-05",
        "last_updated": "2025-03-16",
        "certification_date": "2025-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "UT",
            "license": "10222638-4405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• W. Gene Pead, M.D.
• Peak Wellness Inc
• Katherine Lorraine Pearson
• Stanley Eugene Peay, DDS
• Emily Peck, PA
• Leslie Pena Sandoval
• Terry Don Pendley, LCSW, MSW
• John Christian Penrod, CSW
• Vanessa Pepers, RDH
• Timothy Michael Perdue, DO

• All providers in Bountiful, UT
• Family Nurse Practitioner in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2025; 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.