Marta J Petersen, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

1664261205 Issued in UT

Practice address

50 N Medical Dr
Salt Lake City, UT 84132-1100

Phone

(801) 581-2955

NPI assigned

Sep 20, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 6

Electronic endpoints 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mpetersen16597@direct.med.utah.edu

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.

• Dermatology Division University of Utah Medical Center

  • Dermatology Physician
  • Salt Lake City, UT
  • NPI 1922096114

  Dermatology, UT

  Medicare reassignment Care Compare group NPD
• U-U Pediatric Dermatology

  • Pediatric Dermatology Physician
  • Salt Lake City, UT
  • NPI 1235339193

  UT

  Medicare reassignment NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• University of Utah

  • General Acute Care Hospital
  • Salt Lake City, UT
  • NPI 1487734976

  Hospital

  Care Compare affiliation
• University of Utah

  • General Acute Care Hospital
  • Salt Lake City, UT
  • NPI 1588656870

  Hospital

  Care Compare affiliation
• University of Utah

  • General Acute Care Hospital
  • Salt Lake City, UT
  • NPI 1699889576

  Hospital

  Care Compare affiliation

Specialty

Dermatology

Education

University of Utah School of Medicine, 1975

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Dermatology Division University of Utah Medical Center 73 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• University of Utah Hospital and Clinics Hospital, Salt Lake City, UT, CCN 460009

Merit-based Incentive Payment System (MIPS)

Final score

81.84 of 100Reported as group

Quality

87.03

Promoting interoperability

100

Improvement activities

40

Cost

52.42

Procedures performed for Medicare patients

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636588800000",
    "number": "1972601508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3208",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841103208",
            "telephone_number": "801-587-6340",
            "fax_number": "801-587-6346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 N MEDICAL DR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841321100",
            "telephone_number": "801-581-2955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "MARTA",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2021-11-11",
        "certification_date": "2021-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "UT",
            "license": "1664261205",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "UT",
            "license": "1664261205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003054200",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "870468377001",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "J0854",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "XPY117280",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE PROVIDER #",
            "identifier": "070004834",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002089156",
            "state": "NV"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mpetersen16597@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "UNIVERSITY OF UTAH",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841321100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Karen Petersen
• Kellie Maria Petersen
• Kimberly Petersen
• Lacy Petersen
• Marilyn J Petersen, P.T.
• Peggy B Petersen
• Ray Albert Petersen, ACMHC
• Samantha Petersen
• Scott D Petersen Jr.
• Sydnee Petersen

• All providers in Salt Lake City, UT
• Dermatology Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 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.