Brett T Burtenshaw, MD
Individual provider Active NPI Family Medicine Physician · Syracuse, UT
NPI 1053752121 · NPPES record last updated Jan 5, 2016
Key facts
- NPI
- 1053752121
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 9291245-1205 (UT)
- Practice address
- 2038 W 1900 S
Syracuse, UT 84075-9320 - Phone
- (801) 773-4840
- Fax
- (801) 525-8151
- NPI assigned
- Jul 17, 2013
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Tanner Memorial Clinic
Practice addresses (Care Compare)
2038 W 1900
Syracuse, UT 84075-9320
Phone (801) 773-4840
Hospital & facility affiliations
- Rocky Mountain Hospice - Utah
- Elevation Hospice of Utah, LLC
- Holy Cross Hospital-Davis
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
| Removal of nail tissue | 1-10 |
| Removal or shaving of skin growth | 1-10 |
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 |
|---|---|---|---|---|
| I20150611002561 | UT | Practitioner - Family Practice | 7719113695 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9291245-1205 | UT | MD | Family Medicine Physician |
Practice roles (2 of 4)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tanner Memorial Clinic | Current |
Accepting new patients | |
| Tanner Memorial Clinic | Current |
Accepting new patients |
Locations
425 S 100 W
Layton, UT 84041
Phone (801) 682-8708
1600 W Antelope Dr
Layton, UT 84041
Phone (801) 807-1000
2038 W 1900 S
Syracuse, UT 84075
Phone (801) 773-7899
Networks
- UT PPO
- UT PPO D-SNP
Interoperability endpoints
- brett.burtenshaw.p1@direct.tannerclinic.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 9291245-1205 | UT | Yes |
Addresses
Primary practice location
2038 W 1900 S
Syracuse, UT 84075-9320
Mailing address
PO Box 337
Layton, UT 84041-0337
Phone (801) 773-4840
Other providers in Syracuse, UT
- Jennifer A Brady
- Daniel C. Brandley
- Casey B Brewer
- Brightside Oral Surgery LLC
- Macie Mia Burnett
- Jordan Bybee
- Preston Quinn Calcut
- Michelle Irene Cannon
- Amanda Carlson
- Fernando Cervantes Jr.
All providers in Syracuse, UT · Family Medicine 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 Jan 5, 2016. 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.