David L Peterson, P.A

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

7405325-1206 Issued in UT

Practice address

1055 N 500 W Ste 121
Provo, UT 84604-3305

Phone

(801) 373-7350

Fax

(801) 812-5401

NPI assigned

Jul 20, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Utah Carenow Urgent Care LLCGroup PAC ID 7113326208, 31 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Utah Carenow Urgent Care, LLC

  • Urgent Care Clinic/Center
  • Salt Lake City, UT
  • NPI 1851938997
  Medicare reassignment Care Compare group
• Revere Health PC

  • Multi-Specialty Clinic/Center
  • Provo, UT
  • NPI 1093764805
  Medicare reassignment NPD
• Revere Health PC

  • Multi-Specialty Clinic/Center
  • Spanish Fork, UT
  • NPI 1851142285
  NPD

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

{
    "created_epoch": "1248048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632700800000",
    "number": "1851521249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 N 500 W",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043305",
            "telephone_number": "801-354-8225",
            "fax_number": "801-418-0941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 N 500 W STE 121",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043305",
            "telephone_number": "801-373-7350",
            "fax_number": "801-812-5401"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3000 N Triumph Blvd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Lehi",
            "state": "UT",
            "postal_code": "840434999",
            "country_code": "US",
            "telephone_number": "801-763-3885",
            "fax_number": "801-763-3887",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3550 N University Ave",
            "address_2": "Ste 250",
            "address_purpose": "LOCATION",
            "city": "Provo",
            "state": "UT",
            "postal_code": "846046683",
            "country_code": "US",
            "telephone_number": "801-374-9625",
            "fax_number": "801-374-9690",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "DAVID",
        "middle_name": "L",
        "credential": "P.A",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-20",
        "last_updated": "2021-09-27",
        "certification_date": "2021-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "7405325-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Medreview@reverehealth.com",
            "affiliation": "Y",
            "affiliationName": "Revere Health PC",
            "address_1": "1055 N 500 W",
            "city": "Provo",
            "state": "UT",
            "country_code": "US",
            "postal_code": "846043305",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Medreview@reverehealth.com",
            "affiliation": "Y",
            "affiliationName": "Revere Health PC",
            "address_1": "3000 N Triumph Blvd Ste 100",
            "city": "Lehi",
            "state": "UT",
            "country_code": "US",
            "postal_code": "840434999",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Byron Ray Peterson, HSW
• Carli Elizabeth Peterson
• Chrisitne Peterson, NNP
• Clarissa L Peterson, P.A.
• Clint W Peterson, APRN
• Diane J. Peterson, LMFT
• Jennifer Griffith Peterson, LMFT
• Joshua Phillip Peterson
• Kirstin Chantell Peterson
• Lee M Peterson, MD

• Physician Assistant in Provo, UT
• Providers in Provo, UT by specialty
• Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.