Active NPI
Shannon Peck, PA-C
- Physician Assistant
- American Fork, UT
National Provider Identifier
1346531928
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 7890710-1206
- Practice address
- 1159 E 200 N
#250
American Fork, UT 84003-2022 - Phone
- (801) 855-2980
- NPI assigned
- Apr 29, 2011
- Sex
- Female
- Sole proprietor
- Yes
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 | 7890710-1206 | UT | Primary |
Addresses
Primary practice location
1159 E 200 N
#250
American Fork, UT 84003-2022
Mailing address
1159 E 200 N
#250
American Fork, UT 84003-2022
Phone (801) 855-2980
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NV
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1900 Idaho St
Suite 102
Elko, NV 89801-2637
Phone (775) 753-9799
Merit-based Incentive Payment System (MIPS)
- Final score
- 75 of 100
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1304035200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1304035200000",
"number": "1346531928",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1159 E 200 N",
"address_2": "#250",
"city": "AMERICAN FORK",
"state": "UT",
"postal_code": "840032022",
"telephone_number": "801-855-2980"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1159 E 200 N",
"address_2": "#250",
"city": "AMERICAN FORK",
"state": "UT",
"postal_code": "840032022",
"telephone_number": "801-855-2980"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PECK",
"first_name": "SHANNON",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-04-29",
"last_updated": "2011-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "UT",
"license": "7890710-1206",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in American Fork, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2011; 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.