NPIMap

Individual provider Active NPI

Penny Jean Peacock, M.D.

  • Internal Medicine Physician
  • Park City, UT
National Provider Identifier
1902864762
Registry record updated May 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
3764531205 Issued in UT
Practice address
1612 Ute Blvd
205
Park City, UT 84098-7500
Phone
(435) 655-3309
Fax
(435) 655-3392
NPI assigned
May 2, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 16, 2013

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 3764531205 UT Primary
Pediatrics Physician 208000000X 3764531205 UT
Hospitalist Physician 208M00000X 3764531205 UT

Addresses

Primary practice location

1612 Ute Blvd
205
Park City, UT 84098-7500

Mailing address

1612 Ute Blvd
205
Park City, UT 84098-7500
Phone (435) 655-3309

Other names 1

  • Dr. Penny Jean Peacock Professional name

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
I20031111000328 UT Practitioner - Internal MedicinePractitioner - Pediatric Medicine 0446163877 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
University of Maryland School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Uintah Basin Medical CenterGroup PAC ID 0244131944, 62 clinicians

Practice addresses (Care Compare)

210 W 300
Roosevelt, UT 84066-2336

250 W 300
75 2
Roosevelt, UT 84066-2336
Phone (435) 722-4691

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.32 of 100Reported as apm
Quality
71.89
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
3764531205UTMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northeastern Utah Medical Group Internal Medicine CurrentSince May 3, 2021 Accepting new patients
Uintah Basin Medical Center CurrentSince May 3, 2021 Accepting new patients
Uintah Basin Medical Center CurrentSince May 3, 2021 Accepting new patients
Northeastern Utah Medical Group CurrentSince May 3, 2021 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Park City Internal Medicine - Pediatrics, LC PastSince Jun 28, 2011 Accepting new patients

Locations

50 E 200 S
Duchesne, UT 84021
Phone (435) 738-2426

210 W 300 N
Roosevelt, UT 84066
Phone (435) 722-4691

250 W 300 N
#752
Roosevelt, UT 84066
Phone (435) 722-4691

250 W 300 N
Ste 75
Roosevelt, UT 84066

250 W 300 N
Roosevelt, UT 84066
Phone (435) 722-4691

405 N 500 W
Vernal, UT 84078
Phone (435) 781-2335

475 N 500 W
Vernal, UT 84078
Phone (435) 781-2030

379 N 500 W
Vernal, UT 84078
Phone (435) 781-2030

Organizations & group practices 6

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 8

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": "1146528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1368662400000",
    "number": "1902864762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1612 UTE BLVD",
            "address_2": "205",
            "city": "PARK CITY",
            "state": "UT",
            "postal_code": "840987500",
            "telephone_number": "435-655-3309",
            "fax_number": "435-655-3392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1612 UTE BLVD",
            "address_2": "205",
            "city": "PARK CITY",
            "state": "UT",
            "postal_code": "840987500",
            "telephone_number": "435-655-3309",
            "fax_number": "435-655-3392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEACOCK",
        "first_name": "PENNY",
        "middle_name": "JEAN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-02",
        "last_updated": "2013-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "UT",
            "license": "3764531205",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "UT",
            "license": "3764531205",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "UT",
            "license": "3764531205",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PENNY",
            "last_name": "PEACOCK",
            "middle_name": "JEAN",
            "prefix": "DR.",
            "credential": "MD,FAAP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Park City, UT

Sources for this page

Verify at the official NPI Registry.