Individual provider Active NPI

Fielding Petersen Dunn, PA-C

  • Medical Physician Assistant
  • Salt Lake City, UT
National Provider Identifier
1528491735
Registry record updated Dec 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
8695219-1206 Issued in UT
Practice address
117 W 400 S
Salt Lake City, UT 84101-1916
Phone
(801) 428-4257
NPI assigned
Aug 12, 2013
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 16, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 8695219-1206 UT Primary

Addresses

Primary practice location

117 W 400 S
Salt Lake City, UT 84101-1916

Mailing address

117 W 400 S
Salt Lake City, UT 84101-1916
Phone (801) 428-4257

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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

Enrollment IDStateProvider typePAC IDDetails
I20260313003744 AZ Practitioner - Physician Assistant 7012206865 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Wake Forest University School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

115 E Ogden Ave
Naperville, IL 60563-3103

520 Rose LN
Wickenburg, AZ 85390-1447

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
8695219-1206UTMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Community Hospital Association, Inc. CurrentSince Jan 19, 2026 Accepting new patients
Allred Psychological Services PastSince Dec 18, 2022 Accepting new patients
Granger Medical Clinic PC Past Accepting new patients
Kelly Wosnik Inc PastSince Nov 8, 2020 Accepting new patients
Community Hospital Association, Inc. Past Accepting new patients
Ogden Internal Medicine & Urology LLC Past Accepting new patients

Locations

523 Rose Ln
Wickenburg, AZ 85390
Phone (928) 668-1833

520 Rose Ln
Wickenburg, AZ 85390
Phone (928) 666-1197

1395 W Wickenburg Way
Ste A
Wickenburg, AZ 85390

32919 N Center St
Wittmann, AZ 85361
Phone (928) 668-1833

Organizations & group practices 6

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": "1376265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734307200000",
    "number": "1528491735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 W 400 S",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841011916",
            "telephone_number": "801-428-4257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 W 400 S",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841011916",
            "telephone_number": "801-428-4257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUNN",
        "first_name": "FIELDING",
        "middle_name": "PETERSEN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-08-12",
        "last_updated": "2024-12-16",
        "certification_date": "2024-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "UT",
            "license": "8695219-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.