Active NPI
Jacob Louis Peterson
- Case Manager/Care Coordinator
- Taylorsville, UT
National Provider Identifier
1841600137
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- Practice address
- 5667 S Redwood Rd
Taylorsville, UT 84123-5433 - Phone
- (801) 979-1351
- NPI assigned
- May 7, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | Primary |
Addresses
Primary practice location
5667 S Redwood Rd
Taylorsville, UT 84123-5433
Mailing address
6195 Fox Pointe Cir Apt C1
Park City, UT 84098-7597
Phone (208) 629-9680
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114904646 | Medicaid | UT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1399420800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1399420800000",
"number": "1841600137",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6195 FOX POINTE CIR APT C1",
"city": "PARK CITY",
"state": "UT",
"postal_code": "840987597",
"telephone_number": "208-629-9680"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5667 S REDWOOD RD",
"city": "TAYLORSVILLE",
"state": "UT",
"postal_code": "841235433",
"telephone_number": "801-979-1351"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "JACOB",
"middle_name": "LOUIS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-05-07",
"last_updated": "2014-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1114904646",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Taylorsville, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.