Individual provider Active NPI

Lane O Heder, PA-C

  • Physician Assistant
  • Layton, UT
National Provider Identifier
1083641286
Registry record updated Jan 18, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
378677-1206 Issued in UT
Practice address
3225 W Gordon Ave
Suite 1
Layton, UT 84041-6508
Phone
(801) 397-6150
Fax
(901) 391-6151
NPI assigned
Jun 26, 2006
Last updated
Jan 18, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 378677-1206 UT Primary

Addresses

Primary practice location

3225 W Gordon Ave
Suite 1
Layton, UT 84041-6508

Mailing address

PO Box 5546
Denver, CO 80217-5546
Phone (801) 397-6150

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050630001096 UT Practitioner - Physician Assistant 9133165087 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ogden Clinic PCGroup PAC ID 9638078033, 104 clinicians

Practice addresses (Care Compare)

3225 W Gordon Ave
Suite 1
Layton, UT 84041-5728
Phone (801) 773-7232

5495 S 500
Suite 310
Ogden, UT 84405-7409
Phone (801) 475-3100

6112 S 1550
Ogden, UT 84405-5007
Phone (801) 475-3800

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
378677-1206UTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ogden Clinic Specialty Services LLC Physician Assistant Current Accepting new patients

Locations

3225 W Gordon Ave
Ste 1
Layton, UT 84041
Phone (801) 397-6150

4650 Harrison Blvd
Ogden, UT 84403
Phone (801) 475-3481

5495 S 500 E
Ste 310
Ogden, UT 84405
Phone (801) 475-3100

3485 W 5200 S
Roy, UT 84067
Phone (801) 475-3900

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JJJGBA

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1151280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484697600000",
    "number": "1083641286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5546",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802175546",
            "telephone_number": "801-397-6150",
            "fax_number": "801-397-6151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3225 W GORDON AVE",
            "address_2": "SUITE 1",
            "city": "LAYTON",
            "state": "UT",
            "postal_code": "840416508",
            "telephone_number": "801-397-6150",
            "fax_number": "901-391-6151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEDER",
        "first_name": "LANE",
        "middle_name": "O",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-26",
        "last_updated": "2017-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "378677-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Layton, UT

Sources for this page

Verify at the official NPI Registry.