JESSICA MARIE PETERSEN PA-C
NPI 1699167254
Physician Assistant in Salt Lake City, UT

Q: What is Jessica Petersen's NPI number?

The NPI number for Jessica Petersen is 1699167254. It was assigned to this individual provider in the NPPES registry on February 19, 2015.

Q: What is Jessica Petersen's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Q: When was this NPI record last updated?

The NPPES record for Jessica Petersen was last updated on February 19, 2015. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since February 19, 2015PECOS Enrolled

500 FOOTHILL DR, DEPT OF HOLISTIC MEDICINE, SALT LAKE CITY, UT 84148(801) 582-1565 Get Directions Write a Review

NPPES record last updated: February 19, 2015. Verified against the NPPES registry weekly; last sync: July 19, 2026.

On this page

About Jessica Marie Petersen Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JESSICA MARIE PETERSEN PA-C (NPI 1699167254) is an individual physician assistant in Salt Lake City, Utah and active in the NPI registry since February 2015. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1699167254

Entity TypeIndividualFemale

Primary Taxonomy363A00000X

Provider Legal NameJESSICA MARIE PETERSENCredential: PA-C

Location Address500 FOOTHILL DR, DEPT OF HOLISTIC MEDICINESalt Lake City, UT 84148-0001

Mailing Address500 Foothill Dr, Dept Of Holistic MedicineSalt Lake City, UT 84148-0001

Phone(801) 582-1565

Sole ProprietorNo

Enumeration DateFebruary 19, 2015

✔ NPI 1699167254 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

500 FOOTHILL DR, Salt Lake City, UT 84148

Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jessica Marie Petersen Pa-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 84148 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$84.41 typical visit price

range $54.34 – $166.03

Typical copayment $21.10 (range $13.58 – $41.50)

Most-billed visit code 99203

Established Patient

$68.01 typical visit price

range $17.23 – $135.20

Typical copayment $17.00 (range $4.30 – $33.80)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. ANTHONY W MIDDLETON JR. M.D.

Specialist

500 FOOTHILL DR, SURGERY (UROLOGY)
SALT LAKE CITY, UT 84148

Salt Lake County (801) 531-9453

DR. CARRIE DEKORTE PHARMD, BCPS

Pharmacist (Pharmacotherapy)