Individual provider Active NPI

McKenzie Elise Stenberg, PA-C

  • Physician Assistant
  • Farmington, UT
National Provider Identifier
1508347634
Registry record updated Feb 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
74623481206 Issued in UT
Practice address
1433 N 1075 W Ste 104
Farmington, UT 84025-2746
Phone
(801) 298-1300
NPI assigned
Aug 27, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2019

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 74623481206 UT Primary

Addresses

Primary practice location

1433 N 1075 W Ste 104
Farmington, UT 84025-2746

Mailing address

PO Box 25488
Salt Lake City, UT 84125-0488
Phone (800) 475-3698

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
I20190220002172 UT Practitioner - Physician Assistant 4688912413 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Utah Imaging Associates IncGroup PAC ID 1355394537, 45 clinicians

Practice addresses (Care Compare)

630 Medical Dr
Bountiful, UT 84010-4908
Phone (801) 299-2220

Hospital & facility affiliations

  • Lakeview Hospital Hospital, Bountiful, UT, CCN 460042
  • St Mark'S Hospital Hospital, Salt Lake City, UT, CCN 460047

Merit-based Incentive Payment System (MIPS)

Final score
93.06 of 100Reported as group
Quality
100
Improvement activities
40
Cost
76.86

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
74623481206UTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Scott E Southworth MD PC Past Accepting new patients
Wasatch Vascular Center LLC PastSince Nov 1, 2019 Accepting new patients

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 2

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": "1535328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550534400000",
    "number": "1508347634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 25488",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841250488",
            "telephone_number": "800-475-3698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1433 N 1075 W STE 104",
            "city": "FARMINGTON",
            "state": "UT",
            "postal_code": "840252746",
            "telephone_number": "801-298-1300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STENBERG",
        "first_name": "MCKENZIE",
        "middle_name": "ELISE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-27",
        "last_updated": "2019-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "74623481206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, UT

Sources for this page

Verify at the official NPI Registry.