Peter Corless Anderson, M.D.
Individual provider Active NPI Otolaryngology Physician · West Jordan, UT
NPI 1043444516 · NPPES record last updated Jun 23, 2015
Key facts
- NPI
- 1043444516
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Otolaryngology Physician 207Y00000X
- License
- 5366856-1205 (UT)
- Practice address
- 3584 W 9000 S
Ste. 311
West Jordan, UT 84088-5710 - Phone
- (801) 566-8304
- NPI assigned
- May 12, 2009
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Otolaryngology
- Education
- Saint Louis University School of Medicine, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- South Valley Ear Nose and Throat Associates PLLC
Practice addresses (Care Compare)
3584 W 9000
Suite 311
West Jordan, UT 84088-4775
Phone (801) 566-8304
Hospital & facility affiliations
- Holy Cross Hospital-Jordan Valley
- Intermountain Health Riverton Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140610001432 | UT | Practitioner - Otolaryngology | 0547409195 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5366856-1205 | UT | MD | Otolaryngology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| South Valley Ear Nose and Throat Associates, PLLC | Otolaryngology | Current |
Accepting new patients |
Locations
4651 W 13400 S
Ste 120
Riverton, UT 84096
5169 S Cottonwood St
Ste 310
Salt Lake City, UT 84107
Phone (801) 507-3444
24 W Sergeant Court Dr
Ste 102
Saratoga Springs, UT 84045
Phone (801) 407-3048
3584 W 9000 S
Ste 311
West Jordan, UT 84088
Phone (801) 566-8304
Interoperability endpoints
- southvalleyent.peteranderson@153057.advancedmd-direct.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 5366856-1205 | UT | Yes |
Addresses
Primary practice location
3584 W 9000 S
Ste. 311
West Jordan, UT 84088-5710
Mailing address
3584 W 9000 S
Ste. 311
West Jordan, UT 84088-5710
Phone (801) 566-8304
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5366856-1205 | Other | UT | STATE MEDICAL LICENSE |
Other providers in West Jordan, UT
- Brisma Paulina Anderson
- Deryk L Anderson
- Kristen Ann Anderson
- Megan Danielle Anderson
- Melissa Dawn Anderson
- Roberta Francis Anderson
- Lindsie Anderton
- Ashley Andreasen
- Rachel Maragret Andrews
- Espra L Andrus
All providers in West Jordan, UT · Otolaryngology Physician in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 23, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.