NPIMap

Individual provider Active NPI

Martha P Mandujano, PA-C

  • Physician Assistant
  • Salt Lake City, UT
National Provider Identifier
1356446215
Registry record updated Nov 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
6028041-1206 Issued in UT
Practice address
4745 S 3200 W
Salt Lake City, UT 84118-2822
Phone
(801) 964-6214
Fax
(801) 982-9232
NPI assigned
Sep 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2021

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 6028041-1206 UT Primary

Addresses

Primary practice location

4745 S 3200 W
Salt Lake City, UT 84118-2822

Mailing address

3536 S 1100 E
Salt Lake City, UT 84106-2451
Phone (801) 347-3520

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mmandujano103326@direct.med.utah.edu Direct University of Utah

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
I20060425000009 UT Practitioner - Physician Assistant 1456361278 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University of Utah Community Physicians GroupGroup PAC ID 9739403569, 277 clinicians

Practice addresses (Care Compare)

1525 W 2100
Salt Lake City, UT 84119-1407
Phone (801) 213-9900

Hospital & facility affiliations

  • University of Utah Hospital and Clinics Hospital, Salt Lake City, UT, CCN 460009

Merit-based Incentive Payment System (MIPS)

Final score
89.01 of 100Reported as group
Quality
94.06
Promoting interoperability
100
Improvement activities
40
Cost
69.32

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
6028041-1206UTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Community Physicians Group CurrentSince Nov 11, 2018 Accepting new patients
University of Utah Community Physicians Group CurrentSince Nov 11, 2018 Accepting new patients
Jordan Landing Family Medicine LLC CurrentSince Nov 1, 2014 Accepting new patients
University of Utah Community Physicians Group Past Accepting new patients

Locations

1525 W 2100 S
Salt Lake City, UT 84119
Phone (801) 213-8841

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

3895 W 7800 S
Ste 100
West Jordan, UT 84088
Phone (801) 280-7774

Interoperability endpoints

  • Direct secure messaging: mmandujano103326@direct.med.utah.edu

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 and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637366400000",
    "number": "1356446215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3536 S 1100 E",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841062451",
            "telephone_number": "801-347-3520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4745 S 3200 W",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841182822",
            "telephone_number": "801-964-6214",
            "fax_number": "801-982-9232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANDUJANO",
        "first_name": "MARTHA",
        "middle_name": "P",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-14",
        "last_updated": "2021-11-20",
        "certification_date": "2021-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "6028041-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmandujano103326@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.