NPIMap

Individual provider Active NPI

Anna Lind Petersen, PA

  • Medical Physician Assistant
  • Salt Lake City, UT
National Provider Identifier
1750577813
Registry record updated Nov 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
4985588-1206 Issued in UT
Practice address
6360 S 3000 E
Ste 100
Salt Lake City, UT 84121-6923
Phone
(801) 365-1032
Fax
(801) 365-1036
NPI assigned
Sep 21, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2021

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 4985588-1206 UT Primary

Addresses

Primary practice location

6360 S 3000 E
Ste 100
Salt Lake City, UT 84121-6923

Mailing address

2295 Foothill Dr
Salt Lake City, UT 84109-4000
Phone (801) 486-3021

Other identifiers 1

IdentifierTypeStateIssuer
4985588-1206OtherUTUT STATE LICENSE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address apetersen257007@direct.med.utah.edu Direct UNIVERSITY OF UTAH

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
I20071030000459 UT Practitioner - Physician Assistant 6901993559 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Practice addresses (Care Compare)

400 C St
Salt Lake City, UT 84143-1005
Phone (801) 321-1123

5121 S Cottonwood St
Murray, UT 84107-5701

5171 S Cottonwood St
Suite 210
Murray, UT 84107-5718
Phone (801) 507-3380

8 TH Ave and C St
LDS Hosp Eeg Phys GRP
Salt Lake City, UT 84143
Phone (801) 507-7000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4985588-1206UTMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services, Inc. CurrentSince Mar 25, 2022 Accepting new patients
Foothill Clinic, LLC CurrentSince Sep 10, 2007 Accepting new patients
University of Utah Adult Services CurrentSince Aug 1, 2017 Accepting new patients
University of Utah Adult Services CurrentSince Aug 1, 2017 Accepting new patients
Ihc Health Services Inc CurrentSince Mar 25, 2022 Accepting new patients

Locations

5171 S Cottonwood St
Ste 210
Salt Lake City, UT 84107

6360 S 3000 E
Ste 100
Salt Lake Cty, UT 84121
Phone (801) 365-1032

400 C St
Salt Lake Cty, UT 84143
Phone (435) 688-4080

2295 S Foothill Dr
Slc, UT 84109
Phone (801) 486-3021

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

Interoperability endpoints

  • FHIR API: https://epicproxy.et4001.epichosted.com/APIProxyPRD/FFC/api/FHIR/R4
  • Direct secure messaging: apetersen257007@direct.med.utah.edu

Organizations & group practices 8

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.

Hospital & facility affiliations 5

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": "1190332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636588800000",
    "number": "1750577813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2295 FOOTHILL DR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841094000",
            "telephone_number": "801-486-3021",
            "fax_number": "801-485-6339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6360 S 3000 E",
            "address_2": "STE 100",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841216923",
            "telephone_number": "801-365-1032",
            "fax_number": "801-365-1036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "ANNA",
        "middle_name": "LIND",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-21",
        "last_updated": "2021-11-11",
        "certification_date": "2021-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "UT",
            "license": "4985588-1206",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UT STATE LICENSE",
            "identifier": "4985588-1206",
            "state": "UT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "apetersen257007@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": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.