Individual provider Active NPI

Clayton Denning Killpack, MD

  • Anesthesiology Physician
  • Sandy, UT
National Provider Identifier
1528160769
Registry record updated Sep 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
4979083-1205 Issued in UT
Practice address
9660 S 1300 E
Sandy, UT 84094-3762
Phone
(801) 993-9582
Fax
(801) 733-5618
NPI assigned
Sep 1, 2006
Last updated
Sep 8, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 4979083-1205 UT Primary
Anesthesiology Physician 207L00000X 115334 MT

Addresses

Primary practice location

9660 S 1300 E
Sandy, UT 84094-3762

Mailing address

2975 Executive Pkwy
200
Lehi, UT 84043-9642
Phone (801) 990-1911

Other practice location 1

1101 26th St S
Great Falls, MT 59405-5161
Phone (406) 731-8888

Other identifiers 14

IdentifierTypeStateIssuer
107027653101OtherUTIHC
2090168OtherUTUNITED HEALTHCARE
77516OtherUTPEHP
826031OtherUTHEALTHY U
49790831200001OtherUTBCBS
806874300MedicaidID
850808OtherUTDESERET MUTUAL
870545614KILOtherUTEDUCATORS MUTUAL
100503296MedicaidNV
119676600MedicaidWY
1502954OtherUTUMWA
859647MedicaidAZ
QM0000075886OtherUTALTIUS
TPRA09320OtherUTMOLINA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT, MT, OR, NY4 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 4

Enrollment IDStateProvider typePAC IDDetails
I20040608001326 UT Practitioner - Anesthesiology 1850374133 Reassigns benefits to 2 organizations
I20221104000674 MT Practitioner - Anesthesiology 1850374133 Reassigns benefits to 1 organization
I20230811002828 OR Practitioner - Anesthesiology 1850374133 Reassigns benefits to 1 organization
I20260213003134 NY Practitioner - Anesthesiology 1850374133 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Benefis Hospitals IncGroup PAC ID 1153235296, 390 clinicians
U of R Anesthesiology GroupGroup PAC ID 3476451105, 340 clinicians
Western Anesthesia Associates LLCGroup PAC ID 3274590856, 17 clinicians

Practice addresses (Care Compare)

1101 26TH St S
Great Falls, MT 59405-5161
Phone (406) 455-5000

601 Elmwood Ave
Rochester, NY 14642-0001
Phone (585) 275-2141

630 Medical Dr
Bountiful, UT 84010-4908
Phone (801) 299-2160

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
115334MTMDAnesthesiology Physician
4979083-1205UTMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Western Anesthesia Associates LLC Anesthesiology CurrentSince Jan 1, 2022 Accepting new patients
Mountain West Anesthesia LLC Anesthesiology CurrentSince Jul 1, 2004 Accepting new patients
U of R Anesthesiology Group Anesthesiology CurrentSince Jan 26, 2026 Accepting new patients
Benefis Hospitals Inc CurrentSince Oct 21, 2022 Accepting new patients
Columbia Anesthesia Group P S Anesthesiology CurrentSince Jul 19, 2023 Accepting new patients
Benefis Hospitals, Inc. CurrentSince Oct 21, 2022 Accepting new patients

Locations

1101 26th St S
Great Falls, MT 59405
Phone (406) 455-4690

1101 26th St S
Fl 5
Great Falls, MT 59405
Phone (406) 455-2132

1401 25th St S
Great Falls, MT 59405
Phone (406) 455-3650

601 Elmwood Ave
#604
Rochester, NY 14642
Phone (585) 275-2141

1015 NW 22nd Ave
Portland, OR 97210
Phone (503) 413-7582

7300 SW Childs Rd
Ste A
Tigard, OR 97224
Phone (360) 828-5396

630 Medical Dr
North Salt Lake, UT 84010
Phone (801) 292-6231

150 W Civic Center Dr
Ste 200
Sandy, UT 84070
Phone (801) 727-2056

9660 S 1300 E
Sandy, UT 84094
Phone (801) 314-2417

1380 E Medical Center Dr
St George, UT 84790
Phone (435) 251-2992

1380 E Medical Center Dr
#P
St George, UT 84790
Phone (435) 251-2355

505 NE 87th Ave
Ste 210
Vancouver, WA 98664
Phone (360) 828-5396

Organizations & group practices 6

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.

Hospital & facility affiliations 5

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": "1157068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662595200000",
    "number": "1528160769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2975 EXECUTIVE PKWY",
            "address_2": "200",
            "city": "LEHI",
            "state": "UT",
            "postal_code": "840439642",
            "telephone_number": "801-990-1911",
            "fax_number": "801-990-1912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9660 S 1300 E",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840943762",
            "telephone_number": "801-993-9582",
            "fax_number": "801-733-5618"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1101 26th St S",
            "address_purpose": "LOCATION",
            "city": "Great Falls",
            "state": "MT",
            "postal_code": "594055161",
            "country_code": "US",
            "telephone_number": "406-731-8888",
            "fax_number": "406-731-8318",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KILLPACK",
        "first_name": "CLAYTON",
        "middle_name": "DENNING",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-01",
        "last_updated": "2022-09-08",
        "certification_date": "2022-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "UT",
            "license": "4979083-1205",
            "primary": true
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MT",
            "license": "115334",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IHC",
            "identifier": "107027653101",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "2090168",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEHP",
            "identifier": "77516",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHY U",
            "identifier": "826031",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "49790831200001",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806874300",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DESERET MUTUAL",
            "identifier": "850808",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EDUCATORS MUTUAL",
            "identifier": "870545614KIL",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100503296",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119676600",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UMWA",
            "identifier": "1502954",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "859647",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALTIUS",
            "identifier": "QM0000075886",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MOLINA",
            "identifier": "TPRA09320",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sandy, UT

Sources for this page

Verify at the official NPI Registry.