Andrew Wade Phippen

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

284016-2401 Issued in UT

Practice address

2960 E Casto LN
Holladay, UT 84117-7123

Phone

(801) 556-1866

Fax

(801) 649-5966

NPI assigned

Apr 27, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Elite Healthcare Providers LLCGroup PAC ID 1658650361, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Elite Healthcare Providers LLC

  • Internal Medicine Physician
  • Lehi, UT
  • NPI 1346795325
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1461715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620000000000",
    "number": "1083069025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2960 E CASTO LN",
            "city": "HOLLADAY",
            "state": "UT",
            "postal_code": "841177123",
            "telephone_number": "801-556-1866",
            "fax_number": "801-576-7536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2960 E CASTO LN",
            "city": "HOLLADAY",
            "state": "UT",
            "postal_code": "841177123",
            "telephone_number": "801-556-1866",
            "fax_number": "801-649-5966"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "383 E 60 S",
            "address_purpose": "LOCATION",
            "city": "American Fork",
            "state": "UT",
            "postal_code": "840033835",
            "country_code": "US",
            "telephone_number": "801-576-6417",
            "fax_number": "801-576-7536",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHIPPEN",
        "first_name": "ANDREW",
        "middle_name": "WADE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-27",
        "last_updated": "2021-05-03",
        "certification_date": "2021-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "UT",
            "license": "284016-2401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard Kyle Petersen
• Julia Peterson, CSW
• Bryn Petron
• Trisha Lynne Phaklides, L.AC.
• Nathan Paul Philpott, DPT
• Physical Therapy Express
• Evert Theodore Pierce
• Pine Mountain Home Health, LLC
• Pinnacle Recovery Center LLC
• Precision Dental Care, Inc.

• Physical Medicine & Rehabilitation Physician in Holladay, UT
• Providers in Holladay, UT by specialty
• Physical Medicine & Rehabilitation Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.