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SHANE L PETERSEN MD
NPI 1770593246
Anesthesiology in Murray, UT

Active since August 08, 2006PECOS EnrolledAccepts Medicare Assignment
79.72/100
CMS Quality Rating
5121 S COTTONWOOD STREET, INTERMOUNTAIN MEDICAL CENTER, MURRAY, UT 84157(801) 507-5248(801) 733-5618 Get Directions Write a Review

NPPES record last updated: December 29, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Shane L Petersen Md NPPES

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

SHANE L PETERSEN MD (NPI 1770593246) is an individual anesthesiology provider in Murray, Utah, licensed in Utah (2434068-1205) and active in the NPI registry since August 2006. He is enrolled in Medicare PECOS, is affiliated with Mercy Medical Center, and is a graduate of University Of Utah School Of Medicine (2001).

NPPES Registry Identity

NPI1770593246
Entity TypeIndividualMale
Primary Taxonomy207L00000X
Provider Legal NameSHANE L PETERSENCredential: MD
Location Address5121 S COTTONWOOD STREET, INTERMOUNTAIN MEDICAL CENTERMurray, UT 84157
Mailing Address3340 North Center St #800Lehi, UT 84043-7406 · (801) 990-1911 · Fax (801) 990-1912
Phone(801) 507-5248
Fax(801) 733-5618
Sole ProprietorNo
Medical School CMSUniversity Of Utah School Of MedicineGraduated 2001
Enumeration DateAugust 8, 2006
Last NPPES UpdateDecember 29, 2025
NPPES CertifiedDecember 29, 2025
✔ NPI 1770593246 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAnesthesiologyAllopathic & Osteopathic Physicians
Taxonomy Code207L00000X
Licenses✔ Licensed in UT · 2434068-1205✔ Licensed in OR · MD227949
Definition
An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an operation or an obstetric or diagnostic procedure. The anesthesiologist assesses the risk of the patient undergoing surgery and optimizes the patient's condition prior to, during and after surgery. In addition to these management responsibilities, the anesthesiologist provides medical management and consultation in pain management and critical care medicine. Anesthesiologists diagnose and treat acute, long-standing and cancer pain problems; diagnose and treat patients with critical illnesses or severe injuries; direct resuscitation in the care of patients with cardiac or respiratory emergencies, including the need for artificial ventilation; and supervise post-anesthesia recovery.
5121 S COTTONWOOD STREET, Murray, UT 84157
Open in Google Maps ↗

Other Identifiers 13

Other24340681200001UT · Regence Bcbs
Other907869UT · Deseret Mutual
Other107038030101UT · Ihc
Other1502954UT · Umwa
Other83770UT · Pehp
Other99469UT · Healthy U
OtherQM0000075886UT · Altius
Medicaid100506343NV
Medicaid121124200WY
Medicaid807171600ID
OtherQMP000003262280UT · Molina
Other2090168UT · United Healthcare
Medicaid941379AZ

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Select Health.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Shane L Petersen Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID749213494
PECOS Enrollment IDI20050914000395, I20260109000334
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.

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Mercy Medical Center

Acute Care Hospitals · Roseburg, OR
4/5 CMS rating
OwnershipGovernment - Hospital District or Authority
CMS Certification Number380027
Location2700 NW Stewart ParkwayRoseburg, OR 97471 · Douglas County
Emergency services Birthing friendly

Intermountain Medical Center

Acute Care Hospitals · Murray, UT
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number460010
Location5121 South Cottonwood StreetMurray, UT 84107 · Salt Lake County
Emergency services Birthing friendly

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

79.72/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality82.84
Improvement Activities40
Cost63.86

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.

JUSTIN M ADEN MD
Anesthesiology
5121 S COTTONWOOD STREET, INTERMOUNTAIN MEDICAL CENTER
MURRAY, UT 84157
Salt Lake County (801) 507-5248
ETHAN K FISHER MD
Anesthesiology
5121 S COTTONWOOD STREET, INTERMOUNTAIN MEDICAL CENTER
MURRAY, UT 84157
Salt Lake County (801) 507-5248
DR. JAYAPRAKASH MOODALAGIRIAPPA MD
Anesthesiology
5121 S COTTONWOOD STREET, INTERMOUNTAIN MEDICAL CENTER
MURRAY, UT 84157
Salt Lake County (801) 507-5248
SCOTT NATHAN HURST M.D.
Anesthesiology
5121 S COTTONWOOD STREET, INTERMOUNTAIN MEDICAL CENTER
MURRAY, UT 84157
Salt Lake County (801) 507-5248
DR. BRIAN PAUL MATTHEWS M.D.
Anesthesiology
5121 S COTTONWOOD STREET, INTERMOUNTAIN MEDICAL CENTER
MURRAY, UT 84157
Salt Lake County (801) 507-5248
SCOTT LYLES PROVOST MD
Anesthesiology
5121 S COTTONWOOD STREET, INTERMOUNTAIN MEDICAL CENTER
MURRAY, UT 84157
Salt Lake County (801) 507-5248
DR. KEVIN MICHAEL CUMMISFORD M.D.
Anesthesiology
5121 S COTTONWOOD STREET, INTERMOUNTAIN MEDICAL CENTER
MURRAY, UT 84157
Salt Lake County (801) 507-5248
RYAN WILLIAM NELSON MD
Anesthesiology
5121 S COTTONWOOD STREET, INTERMOUNTAIN MEDICAL CENTER
MURRAY, UT 84157
Salt Lake County (801) 507-5248

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shane Petersen's NPI number?

The NPI number for Shane Petersen is 1770593246. It was assigned to this individual provider in the NPPES registry on August 8, 2006.

Where is Shane Petersen located?

Shane Petersen practices at 5121 S Cottonwood Street Intermountain Medical Center, Murray, UT 84157. The listed phone number is (801) 507-5248.

What is Shane Petersen's specialty?

The primary specialty registered for this NPI is Anesthesiology with taxonomy code 207L00000X.

Is Shane Petersen enrolled in Medicare?

Yes. Shane Petersen is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Shane Petersen accept?

Health plans from Select Health list Shane Petersen as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Shane Petersen affiliated with any hospitals?

According to CMS data, Shane Petersen is affiliated with Mercy Medical Center and Intermountain Medical Center.

When was this NPI record last updated?

The NPPES record for Shane Petersen was last updated on December 29, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.