Stephanie Boulter, PA-C
Individual provider Active NPI Physician Assistant · Cottonwood Heights, UT
NPI 1295970515 · NPPES record last updated Aug 12, 2025
Key facts
- NPI
- 1295970515
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- Practice address
- 1265 E Fort Union Blvd Ste 120
Cottonwood Heights, UT 84047-1845 - Phone
- (801) 917-5561
- Fax
- (800) 775-1064
- NPI assigned
- Dec 16, 2008
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2008
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1265 E Fort Union Blvd
Suite 120
Cottonwood Heights, UT 84047-1845
Phone (801) 917-5561
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 |
|---|---|---|---|---|
| I20091020000500 | UT | Practitioner - Physician Assistant | 2567509730 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Arts, Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ryan K Anderson D P M P C | Past | Accepting new patients |
Interoperability endpoints
- surgicalsynergy.stephanieboulter@134582.advancedmd-direct.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Yes |
Addresses
Primary practice location
1265 E Fort Union Blvd Ste 120
Cottonwood Heights, UT 84047-1845
Mailing address
8132 S 3500 E
Cottonwood Heights, UT 84121-5956
Phone (801) 995-1235
Other providers in Cottonwood Heights, UT
- Mackenzie Elise Bohn
- Melissa A Boll
- Nicholas Bolton
- Carl Bombardier
- Suresh Boodram
- Michael Spenser Bowen
- Lennea R Bower
- Lori Bowser
- Chloe Caitlyn Bramwell
- Ariel Branden
All providers in Cottonwood Heights, UT · Physician Assistant 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 12, 2025. 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.