Kellen Tage Hansen, D.O.

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

10266619-1204 Issued in UT

Practice address

3401 N Center St Ste 100
Lehi, UT 84043

Phone

(801) 753-7770

Fax

(801) 753-7775

NPI assigned

Jun 14, 2012

Last updated

Nov 21, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in UT, ID2 enrollments

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 2

Specialty

Family Practice

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Caribou Medical Center, IncGroup PAC ID 7618365701, 35 clinicians

Sportsmed Associates LLCGroup PAC ID 6204140122, 8 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Caribou Medical Center Hospital, Soda Springs, ID, CCN 131309

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Sportsmed Associates LLC

  dba Physicians of Advance Sports & Orthopedic Medicine

  • Sports Medicine (Family Medicine) Physician
  • Lehi, UT
  • NPI 1285013987
  Medicare reassignment Care Compare group NPD
• Caribou Medical Center, Inc

  dba Caribou Medical Center

  • Critical Access Hospital
  • Soda Springs, ID
  • NPI 1942970272
  Medicare reassignment Care Compare group NPD
• Ihc Health Services Inc

  • Multi-Specialty Clinic/Center
  • Sandy, UT
  • NPI 1942325154
  Medicare reassignment NPD
• Ihc Health Services Inc

  dba Dixie Neonatology

  • Neonatal-Perinatal Medicine Physician
  • St George, UT
  • NPI 1891098679
  NPD
• Ihc Health Services, Inc.

  dba St George Adolescent Partial Hospitalization

  • Psychiatry Physician
  • St George, UT
  • NPI 1023843844
  NPD
• Caribou Medical Center, Inc

  dba Lakeview Medical Clinic

  • Rural Health Clinic/Center
  • Soda Springs, ID
  • NPI 1548930878
  NPD
• Interventional Spine & Pain Management

  • Pain Medicine Physician
  • Ogden, UT
  • NPI 1992342414
  NPD (past)
• University Medical Diagnostic Associates, Inc.

  • Internal Medicine Physician
  • Indianapolis, IN
  • NPI 1861441537
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Caribou Medical Center, Inc

  dba Caribou Medical Center

  • Critical Access Hospital
  • Soda Springs, ID
  • NPI 1942970272
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1339632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574294400000",
    "number": "1396007316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 N CENTER ST STE 100",
            "city": "LEHI",
            "state": "UT",
            "postal_code": "840437498",
            "telephone_number": "801-753-7770",
            "fax_number": "801-753-7775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 N CENTER ST STE 100",
            "city": "LEHI",
            "state": "UT",
            "postal_code": "84043",
            "telephone_number": "801-753-7770",
            "fax_number": "801-753-7775"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12473 S Minuteman Dr",
            "address_purpose": "LOCATION",
            "city": "Draper",
            "state": "UT",
            "postal_code": "840207870",
            "country_code": "US",
            "telephone_number": "801-495-7970",
            "fax_number": "801-495-7990",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "205 N Tillotson Ave",
            "address_purpose": "LOCATION",
            "city": "Muncie",
            "state": "IN",
            "postal_code": "473043900",
            "country_code": "US",
            "telephone_number": "765-288-1928",
            "fax_number": "765-741-0335",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12473 S Minuteman Dr",
            "address_purpose": "LOCATION",
            "city": "Draper",
            "state": "UT",
            "postal_code": "840207870",
            "country_code": "US",
            "telephone_number": "801-495-7970",
            "fax_number": "801-495-7990",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3943 E Pony Express Pkwy Ste 210",
            "address_purpose": "LOCATION",
            "city": "Eagle Mountain",
            "state": "UT",
            "postal_code": "840055544",
            "country_code": "US",
            "telephone_number": "801-789-3030",
            "fax_number": "801-789-3039",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HANSEN",
        "first_name": "KELLEN",
        "middle_name": "TAGE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-14",
        "last_updated": "2019-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IN",
            "license": "02004307A",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "10266619-1204",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02004307A",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IN",
            "license": null,
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "UT",
            "license": "10266619-1204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Courtney Renee' Hancock
• Sadie Hanks Larrabee
• Avery Brooke Hansen, CCC-SLP
• Dalin G Hansen, DPT
• Emma Hansen
• Rachel Hansen, PA-C
• Elizabeth Harding, NP-C
• Hardy Smiles Pediatric Dentistry
• Troy Hardy, DMD
• Harmon City, Inc (Harmons Pharmacy #18)

• Sports Medicine (Family Medicine) Physician in Lehi, UT
• Providers in Lehi, UT by specialty
• Sports Medicine (Family Medicine) Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.