Organization Active NPI

Peak Plastic Surgery, PLLC

  • Plastic Surgery Physician
  • Draper, UT
National Provider Identifier
1477041101
Registry record updated Sep 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
Legal business name
PEAK PLASTIC SURGERY, PLLC
Practice address
11762 S State St Ste 320
Draper, UT 84020-7166
Phone
(801) 702-9191
Fax
(877) 326-3388
NPI assigned
Apr 27, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2025

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

Authorized official

Name
Denise Richards
Title
Billing Manager
Phone
(801) 602-2997

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208200000X Primary

Addresses

Primary practice location

11762 S State St Ste 320
Draper, UT 84020-7166

Mailing address

11762 S State St Ste 320
Draper, UT 84020-7166
Phone (801) 702-9191

Other names 1

  • Peak Prosthetics Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200622000488 UT Part B Supplier - Clinic/Group Practice 3870915887 Receives reassigned benefits from 3 practitioners
Practice locations: Provo, UT; Park City, UT
O20210908001954 UT Part B Supplier - Clinic/Group Practice 6901202449 Receives reassigned benefits from 3 practitioners
Practice locations: Draper, UT; Provo, UT

National Provider Directory

National Provider Directory

Locations

6686 S Highland Dr
Cottonwood Heights, UT 84121
Phone (801) 647-5522

96 E Kimballs Ln
Ste 304
Draper, UT 84020
Phone (801) 571-9433

11762 S State St
Ste 320
Draper, UT 84020
Phone (801) 380-3894

11762 S State St
Ste 315
Draper, UT 84020

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1524787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756771200000",
    "number": "1477041101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11762 S STATE ST STE 320",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840207166",
            "telephone_number": "801-702-9191",
            "fax_number": "877-326-3388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11762 S STATE ST STE 320",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840207166",
            "telephone_number": "801-702-9191",
            "fax_number": "877-326-3388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEAK PLASTIC SURGERY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-27",
        "last_updated": "2025-09-02",
        "certification_date": "2025-02-20",
        "status": "A",
        "authorized_official_last_name": "RICHARDS",
        "authorized_official_first_name": "DENISE",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "801-602-2997"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peak Prosthetics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Draper, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.