Shane Emeron Carter – Psychiatry Physician

Key facts

NPI: 1245955822
Entity type: Individual (NPI type 1)
Primary specialty: Psychiatry Physician 2084P0800X
License: 5710757-4405 (UT)
Practice address: 4516 S 700 E Ste 370
Murray, UT 84107-8317
Phone: (435) 776-5909
Fax: (435) 776-5909
NPI assigned: Oct 6, 2022
Sex: Male
Sole proprietor: Yes

Organizations & group practices 3

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.

Mountain Mental Health LLC Psychiatric/Mental Health Nurse Practitioner · Salt Lake City, UT · NPI 1588378442

Medicare reassignment Care Compare group NPD PSYCHIATRY · UT
Ampelis Health at Mindful Medical Psychiatry Physician · South Ogden, UT · NPI 1942936091

NPD (past) PSYCHIATRY
Ampelis Health Highland Mental Health Clinic/Center (Including Community Mental Health Center) · Highland, UT · NPI 1003588369

NPD (past) PSYCHIATRY

Medicare Care Compare profile

Specialty: Nurse Practitioner
Education: Other, 2021
Medicare assignment: Accepts the Medicare-approved amount as payment in full
Group practices: Mountain Mental Health LLC (4 clinicians)

Practice addresses (Care Compare)

4516 S 700
Suite 370
Salt Lake City, UT 84107-8317
Phone (801) 918-1786

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: No

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20230601001958	UT	Practitioner - Nurse Practitioner	8325405673	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Nurse Practitioner

State licenses

License	State	Type	Specialty
5710757-4405	UT	MD	Psychiatry Physician

Practice roles

Organization	Specialty	Status	New patients
Mountain Mental Health LLC	Psychiatry	Current since May 1, 2023	Accepting new patients
Ampelis Health Highland	Psychiatry	Past since Oct 10, 2021	Accepting new patients
Ampelis Health at Mindful Medical	Psychiatry	Past since Jul 31, 2022	Accepting new patients

Locations

4516 S 700 E
Ste 370
Salt Lake City, UT 84107
Phone (385) 449-9990

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Psychiatry Physician	2084P0800X	5710757-4405	UT	Yes

Addresses

Primary practice location

4516 S 700 E Ste 370
Murray, UT 84107-8317

Mailing address

4516 S 700 E Ste 370
Murray, UT 84107-8317
Phone (801) 918-1786

Other providers in Murray, UT

Daniel J. Carson, DO
Jody L. Carter, APRN
Mackenzie Carter, MOT, OTR/L
Matthew Alan Carter, MD
Sean Carter
Chelsie Casaus
Brynley Case, MSW, CSW
Mary Michelle Cashman Thomas, MSN, APRN-BC, ACNP
Andreina Caslow
John Trent Casper, MPT

All providers in Murray, UT · Psychiatry 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 Aug 30, 2023. 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.

Verify at the official NPI Registry.