Mitchell Alan Peterson, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

9529304-1205 Issued in UT

Practice address

1268 W South Jordan Pkwy Ste 201
South Jordan, UT 84095-4653

Phone

(801) 254-9700

NPI assigned

May 14, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• Direct secure messaging: familiesfirstpeds.mitchpeterson@119851.advancedmd-direct.com

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.

• Families First Pediatrics LLC

  • Pediatrics Physician
  • West Jordan, UT
  • NPI 1821785270
  NPD (past)

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

{
    "created_epoch": "1400025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1629489596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1268 W SOUTH JORDAN PKWY STE 201",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840954653",
            "telephone_number": "801-254-9700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1268 W SOUTH JORDAN PKWY STE 201",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840954653",
            "telephone_number": "801-254-9700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Mario Capecchi Dr",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841131103",
            "country_code": "US",
            "telephone_number": "801-662-5700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "MITCHELL",
        "middle_name": "ALAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-14",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "UT",
            "license": "9529304-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Connors Petersen, MD
• Brad Niel Peterson, D.C.
• Catherine Peterson
• Johnathon Dahlin Peterson, LCMHC, LPC
• Matthew Wade Peterson, D.C.
• Valerie Peterson
• Zoe Pettersson
• Devrie Pettit, MS, RDN
• Kendal Petty
• Ashley Phan

• Pediatrics Physician in South Jordan, UT
• Providers in South Jordan, UT by specialty
• Pediatrics Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.