Individual provider Active NPI

Benjamin P Aleckson

  • Physician Assistant
  • Salt Lake City, UT
National Provider Identifier
1336896174
Registry record updated Sep 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
12859980-1206 Issued in UT
Practice address
1160 E 3900 S Ste 5000
Salt Lake City, UT 84124-1275
Phone
(801) 261-7479
Fax
(801) 261-7429
NPI assigned
Mar 2, 2022
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 28, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 12859980-1206 UT Primary

Addresses

Primary practice location

1160 E 3900 S Ste 5000
Salt Lake City, UT 84124-1275

Mailing address

2950 N Church St Ste 301
Layton, UT 84040-6590
Phone (801) 771-7771

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221014001365 UT Practitioner - Physician Assistant 0648646778 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mountainstar Specialty Services LLCGroup PAC ID 4688767551, 30 clinicians

Practice addresses (Care Compare)

1160 E 3900
Suite 5000
Salt Lake City, UT 84124-1275
Phone (801) 262-8486

1200 E 3900
Salt Lake City, UT 84124-1300

8846 S Redwood Rd
Suite 121
West Jordan, UT 84088-9366
Phone (801) 569-1999

Hospital & facility affiliations

  • St Mark'S Hospital Hospital, Salt Lake City, UT, CCN 460047
  • Lone Peak Hospital Hospital, Draper, UT, CCN 460060

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

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 and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1646179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664323200000",
    "number": "1336896174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2950 N CHURCH ST STE 301",
            "city": "LAYTON",
            "state": "UT",
            "postal_code": "840406590",
            "telephone_number": "801-771-7771",
            "fax_number": "833-643-2775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1160 E 3900 S STE 5000",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841241275",
            "telephone_number": "801-261-7479",
            "fax_number": "801-261-7429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALECKSON",
        "first_name": "BENJAMIN",
        "middle_name": "P",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-03-02",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "12859980-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.