Mark Sederberg, D.O.

Primary specialty

Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X

License

11741897-1204 Issued in UT

Practice address

590 S Wakara Way
Salt Lake City, UT 84108-1200

Phone

(801) 587-5400

NPI assigned

Mar 25, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physical Medicine and Rehabilitation

Education

University of North Texas HSC, College of Osteopathic Med, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sportsmed Associates LLCGroup PAC ID 6204140122, 8 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• American Fork Hospital Hospital, American Fork, UT, CCN 460023

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

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.

• Sportsmed Associates LLC

  • Sports Medicine (Family Medicine) Physician
  • Lehi, UT
  • NPI 1285013987
  Medicare reassignment Care Compare group NPD
• University of Utah Specialty Services

  • General Practice Physician
  • Salt Lake City, UT
  • NPI 1043614811
  Medicare reassignment NPD
• University of Utah Specialty Services

  • Gynecologic Oncology Physician
  • Salt Lake City, UT
  • NPI 1699179754
  NPD
• University of Utah Specialty Services

  • Maternal & Fetal Medicine Physician
  • Elko, NV
  • NPI 1316324973
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Ihc Health Services, Inc.

  • General Acute Care Hospital
  • Provo, UT
  • NPI 1114025491
  Care Compare affiliation
• Ihc Health Services, Inc.

  • General Acute Care Hospital
  • American Fork, UT
  • NPI 1912014358
  Care Compare affiliation

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

{
    "created_epoch": "1458864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591833600000",
    "number": "1255793576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "590 S WAKARA WAY",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841081200",
            "telephone_number": "801-587-5400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "590 S WAKARA WAY",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841081200",
            "telephone_number": "801-587-5400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1500 S Main St",
            "address_purpose": "LOCATION",
            "city": "Fort Worth",
            "state": "TX",
            "postal_code": "761044917",
            "country_code": "US",
            "telephone_number": "817-702-3431",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SEDERBERG",
        "first_name": "MARK",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-25",
        "last_updated": "2020-06-11",
        "certification_date": "2020-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "UT",
            "license": "11741897-1204",
            "primary": false
        },
        {
            "code": "2081S0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": "UT",
            "license": "11741897-1204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Seth Seay
• Melissa A Seckar
• Leanne Rene Seckinger, OTR
• Christine Al Secody
• Hannah Maria Sedan
• Benson H Sederholm, PHARMD
• Casey Sederman
• Courtney Sedillo, APRN
• Aaron A See, DO
• Cathy M Seegers, APRN

• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.