NPIMap

Individual provider Active NPI

Abbie Lyn Siebenhaar, PAC

  • Medical Physician Assistant
  • Salt Lake City, UT
National Provider Identifier
1295003234
Registry record updated Oct 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
9505091-1206 Issued in UT
Practice address
6360 S 3000 E
Ste 310
Salt Lake City, UT 84121-6923
Phone
(801) 944-3199
Fax
(801) 944-3180
NPI assigned
Dec 5, 2011
Last updated
Oct 14, 2015By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 14, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 9505091-1206 UT
Medical Physician Assistant 363AM0700X 9505091-1206 UT Primary

Addresses

Primary practice location

6360 S 3000 E
Ste 310
Salt Lake City, UT 84121-6923

Mailing address

6360 S 3000 E
Ste 220
Salt Lake City, UT 84121-6923
Phone (801) 944-3199

Other identifiers 2

IdentifierTypeStateIssuer
9505091-1206OtherUTUT LICENSE
5059OtherAZAZ LIC

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
I20151021001937 UT Practitioner - Physician Assistant 7113163635 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Utah Gastroenterology LLCGroup PAC ID 9830174150, 71 clinicians

Practice addresses (Care Compare)

1187 E 3900
Salt Lake City, UT 84124-1201
Phone (801) 263-3041

1393 E Sego Lily Dr
Sandy, UT 84092-4350
Phone (801) 619-9000

620 Medical Dr
Suite 205
Bountiful, UT 84010-5173
Phone (801) 298-0057

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75.45 of 100Reported as group
Quality
47.08
Promoting interoperability
95
Improvement activities
40
Cost
75.26

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
9505091-1206UTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Utah Gastroenterology Single Specialty CurrentSince Oct 1, 2015 Accepting new patients
Utah Gastroenterology, LLC Single Specialty CurrentSince Oct 1, 2015 Accepting new patients
Utah Gastroenterology LLC Single Specialty Past Accepting new patients

Locations

38 W 13775 S
Ste 100
Draper, UT 84020
Phone (801) 727-4280

1187 E 3900 S
Salt Lake Cty, UT 84124
Phone (801) 263-3041

6360 S 3000 E
Ste 220
Salt Lake Cty, UT 84121
Phone (801) 944-3195

6360 S 3000 E
Ste 310
Salt Lake Cty, UT 84121
Phone (801) 944-3144

Interoperability endpoints

  • FHIR API: https://4af267b3-0b17-4e37-b82c-3c19f9bce5de.gastro.prod.fhir.ema-api.com/fhir/r4/

Organizations & group practices 4

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.

Hospital & facility affiliations 7

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": "1323043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444780800000",
    "number": "1295003234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6360 S 3000 E",
            "address_2": "STE 220",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841216923",
            "telephone_number": "801-944-3199",
            "fax_number": "801-944-3180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6360 S 3000 E",
            "address_2": "STE 310",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841216923",
            "telephone_number": "801-944-3199",
            "fax_number": "801-944-3180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIEBENHAAR",
        "first_name": "ABBIE",
        "middle_name": "LYN",
        "credential": "PAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-12-05",
        "last_updated": "2015-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "9505091-1206",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "UT",
            "license": "9505091-1206",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UT LICENSE",
            "identifier": "9505091-1206",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AZ LIC",
            "identifier": "5059",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.