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Active NPI 1104365113 Individual Practitioner Male Practitioner

Derek Petersen , PA-C

Physician Assistant • Ogden, UT

Professional Overview & Biography Verified Profile Summary

Derek Petersen, PA-C is a registered healthcare professional specializing in Physician Assistant in Ogden, UT. Practice services are available at 2240 ADAMS AVE under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

2240 Adams Ave

Ogden, UT 844011511

Telephone 8013935355
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Physician Assistant in Ogden, UT

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 12.5 Yrs
State Avg: 12.1 Yrs
Regional Practice Density
112 Specialists

Practicing in Ogden, UT (1904 Statewide)

Telehealth Adoption Rate
4.5% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2026-02-03
Physician Assistant Primary Specialty

NUCC Taxonomy Code: 363A00000X

State License UT 10232646-1206

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.

Secondary Practice Locations

5285 S 400 E Ste A

Washington Terrace, UT 844057194

Phone: 8013340048

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

30 Associated Practitioners
Heather Larson , PA-C

Physician Assistant

NPI 1023465564

Physician Assistant (Certified)

Sage Ukena , APRN

Nurse Practitioner - Family

NPI 1063771475

Advanced Practice Registered Nurse

Alex Suarez , LCSW

Social Worker

NPI 1083807630

Licensed Clinical Social Worker

Kenneth Garcia , PA-C

Physician Assistant - Surgical

NPI 1154413235

Physician Assistant (Certified)

Jessica Estrada

Social Worker - Clinical

NPI 1164102802
Ty Mccomas , FNP-C

Nurse Practitioner - Family

NPI 1164813184

Family Nurse Practitioner (Certified)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active February 23, 2017

NPI status registered as active in NPPES database

📍
Updated Practice Location February 23, 2017

Registered at 2240 ADAMS AVE, OGDEN, UT 844011511 (Tel: 8013935355)

📍
Updated Business Mailing Address February 23, 2017

Registered at 2240 ADAMS AVE, OGDEN, UT 844011511 (Tel: 8013935355)

👤
Provider Name / Credentials Updated February 23, 2017

Recorded as DEREK PETERSEN, PA-C

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) February 23, 2017

Physician Assistant (License #10232646-1206 in UT)

🟢
Initial NPI Registration & Enumeration February 23, 2017

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1104365113
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: February 23, 2017
Last Update: February 03, 2026
Sole Proprietor: No

Mailing Address

2240 Adams Ave

Ogden, UT 844011511

Phone: 8013935355

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.