NPIMap

Individual provider Active NPI

Adrienne McMaster, PA-C

  • Physician Assistant
  • Logan, UT
National Provider Identifier
1003095373
Registry record updated Nov 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
4985108-1206 Issued in UT
Practice address
2380 N 400 E Ste B
Logan, UT 84341-1756
Phone
(435) 752-5741
NPI assigned
Nov 2, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 4985108-1206 UT Primary
Medical Physician Assistant 363AM0700X 4985108-1206 UT

Addresses

Primary practice location

2380 N 400 E Ste B
Logan, UT 84341-1756

Mailing address

274 N Main St
Logan, UT 84321-3915
Phone (435) 753-1600

Other names 1

  • Adrienne Packham Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address amcmaster81067@direct.med.utah.edu Direct University of Utah

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071210000373 UT Practitioner - Physician Assistant 1355430620 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dermatology Division University of Utah Medical CenterGroup PAC ID 9638073497, 73 clinicians

Practice addresses (Care Compare)

50 N Medical Dr
Salt Lake City, UT 84132-0001
Phone (801) 587-6340

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.84 of 100Reported as group
Quality
87.03
Promoting interoperability
100
Improvement activities
40
Cost
52.42

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
4985108-1206UTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
U-U Pediatric Dermatology PastSince May 24, 2020 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637366400000",
    "number": "1003095373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "274 N MAIN ST",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843213915",
            "telephone_number": "435-753-1600",
            "fax_number": "435-753-9521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2380 N 400 E STE B",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843411756",
            "telephone_number": "435-752-5741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCMASTER",
        "first_name": "ADRIENNE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-02",
        "last_updated": "2021-11-20",
        "certification_date": "2021-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "4985108-1206",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "UT",
            "license": "4985108-1206",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "amcmaster81067@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ADRIENNE",
            "last_name": "PACKHAM",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Logan, UT

Sources for this page

Verify at the official NPI Registry.