NPIMap

Organization Active NPI

Anderson Wellness Group LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Sandy, UT
National Provider Identifier
1245793249
Registry record updated May 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
ANDERSON WELLNESS GROUP LLC
Practice address
9533 S 700 E Ste 203
Sandy, UT 84070-3456
Phone
(801) 792-1034
NPI assigned
Apr 8, 2019
Last updated
May 28, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 28, 2019

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

Authorized official

Name
Dr. Sumer Dawn Anderson, APRNNPI 1992071559
Title
Aprn
Phone
(801) 676-9452

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Psychiatry Physician 2084P0802X NU
Child & Adolescent Psychiatry Physician 2084P0804X NU
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU Primary

Addresses

Primary practice location

9533 S 700 E Ste 203
Sandy, UT 84070-3456

Mailing address

9533 S 700 E Ste 203
Sandy, UT 84070-3456
Phone (801) 792-1034

Other identifiers 1

IdentifierTypeStateIssuer
1992071559MedicaidUT

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL mike@andersonwellness.com Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201117002171 UT Part B Supplier - Clinic/Group Practice 9335550631 Receives reassigned benefits from 16 practitioners
Practice locations: Sandy, UT

National Provider Directory

National Provider Directory
Tax ID family
Anderson Wellness Group LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

45 W Sego Lily Dr
Ste 312
Sandy, UT 84070
Phone (801) 676-9452

9533 S 700 E
Ste 203
Sandy, UT 84070
Phone (801) 792-1034

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1554681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559001600000",
    "number": "1245793249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9533 S 700 E STE 203",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840703456",
            "telephone_number": "801-792-1034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9533 S 700 E STE 203",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840703456",
            "telephone_number": "801-792-1034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDERSON WELLNESS GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-08",
        "last_updated": "2019-05-28",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "SUMER",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "APRN",
        "authorized_official_telephone_number": "801-676-9452",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "2084P0802X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1992071559",
            "state": "UT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "mike@andersonwellness.com",
            "affiliation": "N",
            "endpointDescription": "Business Manager",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "9533 S 700 E Ste 203",
            "city": "Sandy",
            "state": "UT",
            "country_code": "US",
            "postal_code": "840703456",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Sandy, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.