Individual provider Active NPI

Christine M Packard, PA-C

  • Physician Assistant
  • Bountiful, UT
National Provider Identifier
1427159904
Registry record updated Jan 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
7886324-1206 Issued in UT
Practice address
1560 Renaissance Towne Dr
Suite 210
Bountiful, UT 84010-7680
Phone
(801) 397-6100
Fax
(801) 397-6101
NPI assigned
Sep 26, 2006
Last updated
Jan 17, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2017

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 7886324-1206 UT Primary

Addresses

Primary practice location

1560 Renaissance Towne Dr
Suite 210
Bountiful, UT 84010-7680

Mailing address

PO Box 5546
Denver, CO 80217-5546
Phone (801) 397-6100

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111110000240 UT Practitioner - Physician Assistant 6103830278 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ogden Clinic Specialty Services LLCGroup PAC ID 1658781422, 131 clinicians

Practice addresses (Care Compare)

3860 Jackson Ave
Suite 2
Ogden, UT 84403-1979
Phone (801) 627-0515

4650 Harrison Blvd
Ogden, UT 84403-4303
Phone (801) 475-3482

4700 Harrison Blvd
Ogden, UT 84403-4303
Phone (801) 475-3300

6112 S 1550
Ogden, UT 84405-5007
Phone (801) 475-3800

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University Ear Nose and Throat Associates Past Accepting new patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484611200000",
    "number": "1427159904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5546",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802175546",
            "telephone_number": "801-397-6100",
            "fax_number": "801-397-6101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1560 RENAISSANCE TOWNE DR",
            "address_2": "SUITE 210",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840107680",
            "telephone_number": "801-397-6100",
            "fax_number": "801-397-6101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PACKARD",
        "first_name": "CHRISTINE",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-26",
        "last_updated": "2017-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "7886324-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bountiful, UT

Sources for this page

Verify at the official NPI Registry.