NPIMap

Individual provider Active NPI

Clarissa L Peterson, P.A.

  • Physician Assistant
  • Provo, UT
National Provider Identifier
1740513324
Registry record updated May 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
7457934-1206 Issued in UT
Practice address
299 E 900 S Ste 101
Provo, UT 84606-6107
Phone
(801) 374-9660
NPI assigned
Sep 14, 2009
Last updated
May 20, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 7457934-1206 UT Primary

Addresses

Primary practice location

299 E 900 S Ste 101
Provo, UT 84606-6107

Mailing address

589 South State Street
Provo, UT 84606-5056
Phone (801) 429-2000

Other practice location 1

589 S State St
Provo, UT 84606-5056
Phone (801) 420-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140916001645 UT Practitioner - Physician Assistant 0244459774 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Instamobile Care LLCGroup PAC ID 1951758663, 12 clinicians

Practice addresses (Care Compare)

299 E 900
Suite 101
Provo, UT 84606-6107
Phone (801) 429-2000

406 W S Jordan Pkwy
Suite 450
South Jordan, UT 84095-3946
Phone (801) 919-3008

589 S State St
Provo, UT 84606-5056
Phone (801) 429-2000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mountainlands Community Health Center, Inc. Family Medicine CurrentSince Sep 14, 2009 Accepting new patients
Mountainlands Community Health Center Inc Family Medicine CurrentSince Sep 14, 2009 Accepting new patients
Utah Valley Radiology Associates Inc PastSince May 1, 2008 Accepting new patients
Mountainlands Community Health Center, Inc Family Medicine Past Accepting new patients

Locations

299 E 900 S
Ste 101
Provo, UT 84606
Phone (801) 374-9660

589 S State St
Provo, UT 84606
Phone (801) 420-2000

Interoperability endpoints

  • Direct secure messaging: clarissa.peterson.1@11721.direct.athenahealth.com

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1252886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716163200000",
    "number": "1740513324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "589 SOUTH STATE STREET",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846065056",
            "telephone_number": "801-429-2000",
            "fax_number": "801-429-2001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "299 E 900 S STE 101",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846066107",
            "telephone_number": "801-374-9660"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "589 S State St",
            "address_purpose": "LOCATION",
            "city": "Provo",
            "state": "UT",
            "postal_code": "846065056",
            "country_code": "US",
            "telephone_number": "801-420-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "CLARISSA",
        "middle_name": "L",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-14",
        "last_updated": "2024-05-20",
        "certification_date": "2024-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "7457934-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Provo, UT

Sources for this page

Verify at the official NPI Registry.