Miriam Peckham, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

9683730-1205 Issued in UT

Practice address

30 N 1900 E # 1C412
Gme Office
Salt Lake City, UT 84132-2115

Phone

(801) 581-2401

Fax

(801) 585-2507

NPI assigned

Apr 20, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Miriam Young Former name

Electronic endpoints 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Diagnostic Radiology

Education

Loma Linda University School of Medicine, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

University of Utah Adult ServicesGroup PAC ID 0941525273, 1,758 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• University of Utah Hospital and Clinics Hospital, Salt Lake City, UT, CCN 460009
• Memorial Hospital Sweetwater County Hospital, Rock Springs, WY, CCN 531318

Merit-based Incentive Payment System (MIPS)

Final score

89.77 of 100Reported as group

Quality

91.47

Promoting interoperability

100

Improvement activities

40

Cost

74.42

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mpeckham199832@direct.med.utah.edu

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.

• University of Utah Adult Services

  • General Practice Physician
  • Salt Lake City, UT
  • NPI 1114321981
  Medicare reassignment Care Compare group NPD
• University of Utah Adult Services

  • Obstetrics & Gynecology Physician
  • Salt Lake City, UT
  • NPI 1578961447
  NPD
• University of Utah Adult Services

  • Diagnostic Radiology Physician
  • Salt Lake City, UT
  • NPI 1598169419
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• University of Utah

  • General Acute Care Hospital
  • Salt Lake City, UT
  • NPI 1487734976
  Care Compare affiliation
• University of Utah

  • General Acute Care Hospital
  • Salt Lake City, UT
  • NPI 1588656870
  Care Compare affiliation
• University of Utah

  • General Acute Care Hospital
  • Salt Lake City, UT
  • NPI 1699889576
  Care Compare affiliation
• Memorial Hospital of Sweetwater County

  • Critical Access Hospital
  • Rock Springs, WY
  • NPI 1558361949
  Care Compare affiliation

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

{
    "created_epoch": "1303257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636588800000",
    "number": "1598056848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 N 1900 E # 1C412",
            "address_2": "GME OFFICE",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841322115",
            "telephone_number": "801-581-2401",
            "fax_number": "801-585-2507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 N 1900 E # 1C412",
            "address_2": "GME OFFICE",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841322115",
            "telephone_number": "801-581-2401",
            "fax_number": "801-585-2507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PECKHAM",
        "first_name": "MIRIAM",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-20",
        "last_updated": "2021-11-11",
        "certification_date": "2021-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "UT",
            "license": "9683730-1205",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mpeckham199832@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": [
        {
            "first_name": "MIRIAM",
            "last_name": "YOUNG",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Cynthia Jean Peck
• Katie Lyn Peck
• Michael Andrew Peck
• Emma Peckenpaugh
• Lindsay Peckham
• Regina Pectol, SSW
• Victoria Lee Pectol
• Pectus Services of Utah
• Ayush Venkat Peddireddi, MD
• Fufan Pedel, LMFT

• Diagnostic Radiology Physician in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Diagnostic Radiology Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2021; 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.