NPIMap

Individual provider Active NPI

Celeste Knight Peterson, MD

  • Internal Medicine Physician
  • Salt Lake City, UT
National Provider Identifier
1912406919
Registry record updated Dec 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
11917518-1205 Issued in UT
Practice address
1160 E 3900 S Ste 1200
Salt Lake City, UT 84124-1251
Phone
(801) 365-0909
Fax
(801) 261-9656
NPI assigned
Feb 5, 2018
Last updated
Dec 17, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 11917518-1205 UT Primary
Internal Medicine Physician 207R00000X 9965 MT

Addresses

Primary practice location

1160 E 3900 S Ste 1200
Salt Lake City, UT 84124-1251

Mailing address

5630 S Waterbury Way Ste B102
Salt Lake City, UT 84121-6209
Phone (801) 274-2000

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
I20211102001688 UT Practitioner - Internal MedicinePractitioner - Geriatric Medicine 9133478324 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Geriatric Medicine
Education
University of Utah School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Utah Physicians Care Centers PCGroup PAC ID 3971404963, 11 clinicians

Practice addresses (Care Compare)

1160 E 3900
Suite 1200
Salt Lake City, UT 84124-1251
Phone (801) 261-9651

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9965MTMDInternal Medicine Physician
11917518-1205UTMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Utah Physicians Care Centers PC Internal Medicine CurrentSince Nov 1, 2021 Accepting new patients
Utah Physicians Care Center Internal Medicine CurrentSince Dec 21, 2021 Accepting new patients

Locations

5630 S Waterbury Way
Ste B102
Salt Lake Cty, UT 84121
Phone (801) 261-9651

1160 E 3900 S
Ste 1200
Slc, UT 84124
Phone (801) 261-9651

Interoperability endpoints

  • Direct secure messaging: celeste.peterson.1@15147.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/15147/brand/1/csg/1/fhir/r4

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1517788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639699200000",
    "number": "1912406919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5630 S WATERBURY WAY STE B102",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841216209",
            "telephone_number": "801-274-2000",
            "fax_number": "801-274-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1160 E 3900 S STE 1200",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841241251",
            "telephone_number": "801-365-0909",
            "fax_number": "801-261-9656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "CELESTE",
        "middle_name": "KNIGHT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-05",
        "last_updated": "2021-12-17",
        "certification_date": "2021-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "UT",
            "license": "11917518-1205",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MT",
            "license": "9965",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.