Johnathon Ivar Pedersen, FNP-BC in Bountiful, UT

Johnathon Ivar Pedersen, FNP-BC is a medicare enrolled "Nurse Practitioner - Family" in Bountiful, Utah. His current practice location is 230 S Main St, Bountiful, Utah. You can reach out to his office (for appointments etc.) via phone at (801) 698-0544.

Johnathon Ivar Pedersen is licensed to practice in Utah (license number 10222638-4405) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1346056348.

Contact Information

	Johnathon Ivar Pedersen, FNP-BC
	230 S Main St, Bountiful, UT 84010-6236
	(801) 698-0544
	Not Available

Map and Direction

Provider's Profile

Full Name	Johnathon Ivar Pedersen
Gender	Male
Speciality	Nurse Practitioner - Family
Location	230 S Main St, Bountiful, Utah
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1346056348
Provider Enumeration Date: 12/05/2024
Last Update Date: 03/16/2025

Medicare PECOS Information:

PECOS PAC ID: 9537681762
Enrollment ID: I20250318000840

Medical Identifiers

Medical identifiers for Johnathon Ivar Pedersen such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1346056348	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LF0000X	Nurse Practitioner - Family	10222638-4405 (Utah)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Johnathon Ivar Pedersen allows following entities to bill medicare on his behalf.

Entity Name	Valdar Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1336619675 PECOS PAC ID: 8123360534 Enrollment ID: O20190506001707

Entity Name	Option Care Infusion Suites Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1164194601 PECOS PAC ID: 5698179125 Enrollment ID: O20211122002842

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Johnathon Ivar Pedersen is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Johnathon Ivar Pedersen, FNP-BC 230 S Main St, Bountiful, UT 84010-6236 Ph: (801) 698-0544	Johnathon Ivar Pedersen, FNP-BC 230 S Main St, Bountiful, UT 84010-6236 Ph: (801) 698-0544

Reviews and Comments

Nurse Practitioner Nurses in Bountiful, UT

Andrew Garver, Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 415 Medical Dr Ste A100, Bountiful, UT 84010 Phone: 801-683-1062
Kenzlee Wooden, Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 845 S Main St Ste A7, Bountiful, UT 84010 Phone: 801-298-0903
Daelyn Tasha Clawson, RN Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 390 N Main St, Bountiful, UT 84010 Phone: 801-397-6670
Mandi Spens, PMHNP-BC Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 630 Medical Dr, Bountiful, UT 84010 Phone: 801-299-3781
Miss Lauren Lightfield, AGACNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 458 N 500 W, Bountiful, UT 84010 Phone: 801-292-9355 Fax: 801-296-8050
Sarah Elizabeth Mcmillin, Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 111 W 3100 S, Bountiful, UT 84010 Phone: 801-668-7479
Mistie Sue Manning, NP-C Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 1551 Renaissance Towne Dr Ste 370, Bountiful, UT 84010 Phone: 801-747-7244

Johnathon Ivar Pedersen, FNP-BC - Medicare Nurse Practitioner in Bountiful, UT