NPIMap

Individual provider Active NPI

Michael J Sanderson, MD

  • Family Medicine Physician
  • West Jordan, UT
National Provider Identifier
1215134663
Registry record updated Jan 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
11014013A Issued in IN
Practice address
3181 W 9000 S
West Jordan, UT 84088-5610
Phone
(801) 965-3600
NPI assigned
Jun 29, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 11014013A IN Primary

Addresses

Primary practice location

3181 W 9000 S
West Jordan, UT 84088-5610

Mailing address

2965 W 3500 S
West Valley City, UT 84119-3602
Phone (801) 965-3600

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
I20100804000201 UT Practitioner - Family Practice 7911030457 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Utah School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Granger Medical Clinic PCGroup PAC ID 3476465691, 192 clinicians

Practice addresses (Care Compare)

2965 W 3500
West Valley City, UT 84119-3602
Phone (801) 965-3600

Hospital & facility affiliations

  • Auburn Crest Hospice Hospice, Draper, UT, CCN 461620
  • Lone Peak Hospital Hospital, Draper, UT, CCN 460060
  • Intermountain Medical Center Hospital, Murray, UT, CCN 460010
  • Intermountain Health Riverton Hospital Hospital, Riverton, UT, CCN 460058
  • Holy Cross Hospital-Jordan Valley Hospital, West Jordan, UT, CCN 460051

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions22
Removal of nail tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
11014013AINMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Granger Medical Clinic PC Family Medicine Current Accepting new patients
Granger Medical Specialists LLC CurrentSince Oct 9, 2023 Accepting new patients
Granger Medical Clinic PC CurrentSince Dec 26, 2023 Accepting new patients
Granger Medical Specialists, LLC CurrentSince Oct 9, 2023 Accepting new patients
Granger Medical Clinic PC Past Accepting new patients

Locations

12391 S 4000 W
Riverton, UT 84096
Phone (801) 302-1700

995 W Levoy Dr
Taylorsville, UT 84123

7181 S Campus View Dr
Ste 200
West Jordan, UT 84084
Phone (801) 965-3505

7181 S Campus View Dr
West Jordan, UT 84084
Phone (801) 965-3505

3725 W 4100 S
West Valley City, UT 84120
Phone (801) 965-3545

2965 W 3500 S
West Valley City, UT 84119
Phone (801) 965-3505

Networks

  • UT PPO
  • UT PPO D-SNP

Interoperability endpoints

  • Direct secure messaging: michael.sanderson@gmcwv.eclinicaldirectplus.com
  • Direct secure messaging: michael.sanderson.1@20766.direct.athenahealth.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Auburn Crest HospiceDraper, UT, CCN 461620 Hospice Corporate Director Dec 22, 2016

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

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 5

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": "1183075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704931200000",
    "number": "1215134663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2965 W 3500 S",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841193602",
            "telephone_number": "801-965-3600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3181 W 9000 S",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840885610",
            "telephone_number": "801-965-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDERSON",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-29",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "11014013A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Jordan, UT

Sources for this page

Verify at the official NPI Registry.