Peachtree Family Medicine PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

5916429-1205 Issued in UT

Legal business name

PEACHTREE FAMILY MEDICINE PC

Practice address

565 W 465 N Ste 130
Providence, UT 84332-4802

Phone

(435) 752-5553

Fax

(435) 755-5043

NPI assigned

Feb 22, 2007

Last updated

Nov 6, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Vera B Carlson, MDNPI 1023095585

Title

MD

Phone

(435) 752-5553

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Vera B Carlson, MD, PHD

  • Family Medicine Physician
  • Providence, UT
  • NPI 1023095585
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730851200000",
    "number": "1679608582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "169 N GATEWAY DR",
            "address_2": "170",
            "city": "PROVIDENCE",
            "state": "UT",
            "postal_code": "843329855",
            "telephone_number": "435-752-5553",
            "fax_number": "435-755-5043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "565 W 465 N STE 130",
            "city": "PROVIDENCE",
            "state": "UT",
            "postal_code": "843324802",
            "telephone_number": "435-752-5553",
            "fax_number": "435-755-5043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACHTREE FAMILY MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-22",
        "last_updated": "2024-11-06",
        "certification_date": "2024-11-06",
        "status": "A",
        "authorized_official_last_name": "CARLSON",
        "authorized_official_first_name": "VERA",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "435-752-5553",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "5916429-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "225939539001",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Callin Passey, OD
• Violet Rhiannon Patrick, CMHC
• John W Payne, PT
• Ashley Noelle Paynter, ACMHC
• Paz Wellness
• Peak Wellness Group LLC
• Charity Samantha Pearson, RBT
• Rachel Perkins
• Conner Peterson, RBT
• Joshua Allen Peterson, RBT

• Family Medicine Physician in Providence, UT
• Providers in Providence, UT by specialty
• Family Medicine Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.