Individual provider Active NPI

Shawn M Nelson, MD

  • Anesthesiology Physician
  • Providence, UT
National Provider Identifier
1265163489
Registry record updated Jun 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
14229960-1205 Issued in UT
Practice address
560 W 465 N Ste 604
Providence, UT 84332-8006
Phone
(435) 753-1600
Fax
(435) 753-9521
NPI assigned
Jun 20, 2022
Last updated
Jun 19, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 14229960-1205 UT Primary

Addresses

Primary practice location

560 W 465 N Ste 604
Providence, UT 84332-8006

Mailing address

560 W 465 N Ste 604
Providence, UT 84332-8006
Phone (435) 753-1600

Other practice location 1

984455 Nebraska Medical Ctr
Omaha, NE 68198-4455
Phone (402) 559-7353

Other identifiers 1

IdentifierTypeStateIssuer
1265163489MedicaidUT

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260609003749 UT Practitioner - Anesthesiology 4688050297

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Baylor College of Medicine, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Interwest Anesthesia Associates LLCGroup PAC ID 0042293359, 29 clinicians

Practice addresses (Care Compare)

500 E 1400
Logan, UT 84341
Phone (435) 716-1000

National Provider Directory

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

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1655683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781827200000",
    "number": "1265163489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "560 W 465 N STE 604",
            "city": "PROVIDENCE",
            "state": "UT",
            "postal_code": "843328006",
            "telephone_number": "435-753-1600",
            "fax_number": "435-753-9521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "560 W 465 N STE 604",
            "city": "PROVIDENCE",
            "state": "UT",
            "postal_code": "843328006",
            "telephone_number": "435-753-1600",
            "fax_number": "435-753-9521"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "984455 Nebraska Medical Ctr",
            "address_purpose": "LOCATION",
            "city": "Omaha",
            "state": "NE",
            "postal_code": "681984455",
            "country_code": "US",
            "telephone_number": "402-559-7353",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NELSON",
        "first_name": "SHAWN",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-20",
        "last_updated": "2026-06-19",
        "certification_date": "2026-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "UT",
            "license": "14229960-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1265163489",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, UT

Sources for this page

Verify at the official NPI Registry.