Crystal Anne Burtis, PHYSICIAN ASSISTANT

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1054788-1206 Issued in UT

Practice address

1624 N 200 E Ste 160
Logan, UT 84341-3175

Phone

(435) 750-5599

Fax

(435) 750-0861

NPI assigned

Nov 22, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT, NV2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Canyon Medical Group LLC

  • Pediatrics Physician
  • Logan, UT
  • NPI 1952599409
  Medicare reassignment
• Highland Medical PLLC

  • Family Medicine Physician
  • Salt Lake City, UT
  • NPI 1215010327
  Medicare reassignment
• Anywhere Clinic LLC

  • Psychiatry Physician
  • Las Vegas, NV
  • NPI 1316460850
  Medicare reassignment

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

{
    "created_epoch": "1511308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698710400000",
    "number": "1477067775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1624 N 200 E STE 160",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843413175",
            "telephone_number": "435-750-5599",
            "fax_number": "435-750-0861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1624 N 200 E STE 160",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843413175",
            "telephone_number": "435-750-5599",
            "fax_number": "435-750-0861"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6783 S Redwood Rd Ste 103",
            "address_purpose": "LOCATION",
            "city": "West Jordan",
            "state": "UT",
            "postal_code": "840845685",
            "country_code": "US",
            "telephone_number": "435-703-9647",
            "fax_number": "435-703-6003",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1624 N 200 E Ste 160",
            "address_purpose": "LOCATION",
            "city": "Logan",
            "state": "UT",
            "postal_code": "843413175",
            "country_code": "US",
            "telephone_number": "435-703-9647",
            "fax_number": "435-703-6003",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6783 S Redwood Rd Ste 102",
            "address_purpose": "LOCATION",
            "city": "West Jordan",
            "state": "UT",
            "postal_code": "840845696",
            "country_code": "US",
            "telephone_number": "435-703-9647",
            "fax_number": "435-703-6003",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BURTIS",
        "first_name": "CRYSTAL",
        "middle_name": "ANNE",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-11-22",
        "last_updated": "2023-10-31",
        "certification_date": "2023-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "1054788-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Holly Budge
• Reed Bullen, M.D.
• Amy Bunting
• Craig Burdett, P.A.
• Joshua Joel Burnham, DMD
• Marci Kae Buttars, APRN
• Russell Jay Buttars, DPM
• Alan Buys
• BWL Family Holdings, LLC.
• Bradley Curtis Bybee, PA-C

• Physician Assistant in Logan, UT
• Providers in Logan, UT by specialty
• Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.