DEREK PETERSEN (PA-C) – Physician Assistant, NPI 1104365113

DEREK PETERSEN (PA-C) is a healthcare provider. based in Washington terrace, Utah. specializing in Physician Assistant. They hold the professional credentials PA-C. They hold a License No. 10232646-1206 (UT). The NPI Number for DEREK PETERSEN (PA-C) is 1104365113

Main info

Male
Name
DEREK PETERSEN (PA-C)
NPI
1104365113
Phone
(801) 334-0048
Address
5285 S 400 E Ste A
Enumeration Date
23 February 2017
Last Update Date
3 February 2026
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience42
Completeness85
Years active:9State licenses:1Digital endpointsOther names

Provider Addresses for DEREK PETERSEN (PA-C)

  • 5285 S 400 E Ste A

    Washington Terrace, UT 844057194

    Phone: (801) 334-0048

    Fax: (833) 428-8406

    Type: Location

  • 2240, Adams Avenue, 25th Street, Ogden, Weber County, Utah, 84401, United States

    OGDEN, UT 844011511

    Phone: (801) 393-5355

    Fax: (801) 394-4609

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 2 Open Payments records for all available years, with a total value of $32.

Total Amount is formed as General ($32) + Research ($0) + Ownership ($0) = $32.

Last reported payment date: 2024-06-24 • Largest payer in this snapshot: SOBI, INC ($17).

Total Amount

$32

General + Research + Ownership

Payments

2

Total payment records

General Amount

$32

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-06-24

Latest reported date

Top Companies

Largest payers in this snapshot

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Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 84405)

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Reviews

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Frequently asked questions

Is there an official ID for DEREK PETERSEN (PA-C) in U.S. healthcare records?
The official identifier for DEREK PETERSEN (PA-C) is NPI 1104365113.
Is DEREK PETERSEN (PA-C) still an active registrant?
DEREK PETERSEN (PA-C) carries an active NPI according to the public dataset.
What kind of doctor is DEREK PETERSEN (PA-C)?
DEREK PETERSEN (PA-C) is associated with Physician Assistant in the directory — Clinical services aligned with this taxonomy classification.
Where in Utah is DEREK PETERSEN (PA-C) registered?
Use Washington Terrace, Utah as the headline location for DEREK PETERSEN (PA-C) here.
Can I trust this NPI listing for DEREK PETERSEN (PA-C)?
The listing is sourced from the national NPI registry. If something looks off, compare with NPPES and the clinic's website.

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