NPIMap

Individual provider Active NPI

Mark D Anderson, M.D.

  • Diagnostic Radiology Physician
  • Logan, UT
National Provider Identifier
1376540955
Registry record updated Apr 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
376402-1205 Issued in UT
Practice address
1400 N 500 E
Logan, UT 84341-2455
Phone
(435) 716-1000
NPI assigned
Jun 28, 2005
Last updated
Apr 20, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 376402-1205 UT Primary

Addresses

Primary practice location

1400 N 500 E
Logan, UT 84341-2455

Mailing address

PO Box 1108
Bountiful, UT 84011-1108
Phone (801) 296-2113

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT, ID2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20031125000286 UT Practitioner - Diagnostic Radiology 6103720784 Reassigns benefits to 2 organizations
I20040831001285 ID Practitioner - Diagnostic Radiology 6103720784 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Utah School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Practice addresses (Care Compare)

1400 N 500
Logan, UT 84341-2455
Phone (435) 716-1000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
376402-1205UTMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services, Inc. CurrentSince Mar 25, 2018 Accepting new patients
Tellica Imaging, LLC CurrentSince Nov 7, 2023 Accepting new patients
Ihc Health Services, Inc. CurrentSince Jan 12, 2024 Accepting new patients
Ihc Health Services Inc Family Medicine Current Accepting new patients
Ihc Health Services Inc CurrentSince Mar 25, 2018 Accepting new patients
Tellica Imaging, LLC Diagnostic Radiology CurrentSince Nov 7, 2023 Accepting new patients
University Radiology Associates Diagnostic Radiology PastSince Feb 1, 1997 Accepting new patients

Locations

8505 W Overland Rd
Boise, ID 83709
Phone (208) 417-5100

44 N 1st E
Preston, ID 83263
Phone (208) 852-0137

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

5217 S State St
Ste 200
Salt Lake City, UT 84107
Phone (208) 417-5100

36 S Street St
Ste 2200
Salt Lake Cty, UT 84111
Phone (385) 622-0669

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

1380 E Medical Center Dr
St George, UT 84790
Phone (435) 251-2992

1380 E Medical Center Dr
#P
St George, UT 84790
Phone (435) 251-2355

Organizations & group practices 7

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 5

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": "1119916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429488000000",
    "number": "1376540955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1108",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840111108",
            "telephone_number": "801-296-2113",
            "fax_number": "801-296-1715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 N 500 E",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843412455",
            "telephone_number": "435-716-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "MARK",
        "middle_name": "D",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-28",
        "last_updated": "2015-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "UT",
            "license": "376402-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Logan, UT

Sources for this page

Verify at the official NPI Registry.