Mark D Anderson, M.D.
Individual provider Active NPI Diagnostic Radiology Physician · Logan, UT
NPI 1376540955 · NPPES record last updated Apr 20, 2015
Key facts
- NPI
- 1376540955
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- License
- 376402-1205 (UT)
- Practice address
- 1400 N 500 E
Logan, UT 84341-2455 - Phone
- (435) 716-1000
- NPI assigned
- Jun 28, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 5
Medicare Care Compare profile
- 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 Inc
Practice addresses (Care Compare)
1400 N 500
Logan, UT 84341-2455
Phone (435) 716-1000
Hospital & facility affiliations
- Intermountain Health Logan Regional Hospital
- Bear River Valley Hospital
- Intermountain Medical Center
- St. George Regional Hospital
- Intermountain Health McKay-Dee Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in UT, ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20031125000286 | UT | Practitioner - Diagnostic Radiology | 6103720784 | Reassigns benefits to 2 organizations |
| I20040831001285 | ID | Practitioner - Diagnostic Radiology | 6103720784 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 376402-1205 | UT | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ihc Health Services Inc | Family Medicine | Current | Accepting new patients |
| Ihc Health Services, Inc. | Current |
Accepting new patients | |
| Tellica Imaging, LLC | Diagnostic Radiology | Current |
Accepting new patients |
| Ihc Health Services, Inc. | Current |
Accepting new patients | |
| Tellica Imaging, LLC | Current |
Accepting new patients | |
| Ihc Health Services Inc | Current |
Accepting new patients | |
| University Radiology Associates | Diagnostic Radiology | Past |
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
#P
St George, UT 84790
Phone (435) 251-2355
1380 E Medical Center Dr
St George, UT 84790
Phone (435) 251-2992
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 376402-1205 | UT | Yes |
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
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 119134900 | Medicaid | WY | |
| 806574800 | Medicaid | ID | |
| D4922 | Medicaid | UT |
Other providers in Logan, UT
- Jacob Douglas Anderson
- Jennifer H Anderson
- Kathryn Elaine Anderson
- Marie Anderson
- Mark Brian Anderson
- Martin Lee Anderson
- Nathan Anderson
- Nichole L Anderson
- Rachel Ann Anderson
- Suzanne Marie Anderson
All providers in Logan, UT · Diagnostic Radiology Physician in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 20, 2015. 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.