NPIMap

Organization Active NPI

Peterson Market LLC

Doing business as Peterson's Fresh Market

  • Community/Retail Pharmacy
  • Riverton, UT
National Provider Identifier
1780917930
Registry record updated Nov 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
86317321703 Issued in UT
Legal business name
PETERSON MARKET LLC
Doing business as
Peterson's Fresh Market
Practice address
1784 W 12600 S
Riverton, UT 84065-7025
Phone
(801) 254-0809
Fax
(801) 254-5982
NPI assigned
Sep 4, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2016

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

Authorized official

Name
Monte Peterson
Title
Chairman/Owner
Phone
(801) 254-0761

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 86317321703 UT Primary

Addresses

Primary practice location

1784 W 12600 S
Riverton, UT 84065-7025

Mailing address

1784 W 12600 S
Riverton, UT 84065-7025
Phone (801) 254-0809

Other identifiers 1

IdentifierTypeStateIssuer
2140532OtherPK

Other names 1

  • Peterson's Fresh Market Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20101203000620 UT Part B Supplier - Mass Immunization (Roster Biller Only) 9335336312 30 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Salt Lake City, UT; South Ogden, UT; American Fork, UT; Park City, UT; Ogden, UT; Layton, UT; Provo, UT
O20210309002603 UT Part B Supplier - Pharmacy 2860808227 Practice locations: Riverton, UT

Other NPIs on the same Medicare enrollment 18

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 18

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
46D2042888Peterson Market, LLC1784 W 12600 S, Riverton, UT 84065Certificate of waiverJun 20, 2028

National Provider Directory

National Provider Directory

Locations

1784 W 12600 S
Riverton, UT 84065
Phone (801) 245-0809

NPI Registry JSON

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

{
    "created_epoch": "1252022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479081600000",
    "number": "1780917930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1784 W 12600 S",
            "city": "RIVERTON",
            "state": "UT",
            "postal_code": "840657025",
            "telephone_number": "801-254-0809",
            "fax_number": "801-254-5892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1784 W 12600 S",
            "city": "RIVERTON",
            "state": "UT",
            "postal_code": "840657025",
            "telephone_number": "801-254-0809",
            "fax_number": "801-254-5982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSON MARKET LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-04",
        "last_updated": "2016-11-14",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "MONTE",
        "authorized_official_title_or_position": "CHAIRMAN/OWNER",
        "authorized_official_telephone_number": "801-254-0761"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "UT",
            "license": "86317321703",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2140532",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peterson's Fresh Market",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Riverton, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2016; 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.