Individual provider Active NPI

Justin D Atherton, DO

  • Surgery Physician
  • Draper, UT
National Provider Identifier
1386876167
Registry record updated Apr 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
8986480-1204 Issued in UT
Practice address
96 E Kimballs LN Ste 306
Draper, UT 84020-5021
Phone
(801) 999-2432
NPI assigned
Aug 13, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 8986480-1204 UT Primary

Addresses

Primary practice location

96 E Kimballs LN Ste 306
Draper, UT 84020-5021

Mailing address

PO Box 100253
Atlanta, GA 30384-0253

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140612001996 UT Practitioner - General Surgery 5395926703 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2009
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)

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

96 E Kimballs LN
Draper, UT 84020-5021

Hospital & facility affiliations

  • Lone Peak Hospital Hospital, Draper, UT, CCN 460060

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Physician Group of Utah Inc CurrentSince Oct 1, 2015 Accepting new patients
Mountainstar Specialty Services LLC Surgery CurrentSince May 4, 2025 Accepting new patients

Locations

2000 Health Park Dr
Brentwood, TN 37027
Phone (615) 372-5426

96 E Kimballs Ln
Ste 306
Draper, UT 84020
Phone (801) 999-2432

82 S 1100 E
Ste 103
Salt Lake Cty, UT 84102
Phone (801) 505-5370

2530 W 4700 S
Ste B8
Taylorsville, UT 84129
Phone (801) 967-5866

3584 W 9000 S
Ste 304
West Jordan, UT 84088
Phone (801) 568-3150

8846 S Redwood Rd
Ste 121
West Jordan, UT 84088
Phone (801) 545-8480

3580 W 90th S
West Jordan, UT 84088
Phone (801) 263-0810

3336 S Pioneer Pkwy
Ste 201
West Valley City, UT 84120
Phone (801) 313-0555

Organizations & group practices 3

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 1

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": "1250121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744761600000",
    "number": "1386876167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100253",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303840253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "96 E KIMBALLS LN STE 306",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840205021",
            "telephone_number": "801-999-2432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ATHERTON",
        "first_name": "JUSTIN",
        "middle_name": "D",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-13",
        "last_updated": "2025-04-16",
        "certification_date": "2025-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "UT",
            "license": "8986480-1204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Draper, UT

Sources for this page

Verify at the official NPI Registry.