Benjamin Sumner, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

1275 E Fairfax Rd
Salt Lake City, UT 84103-4324

Phone

(801) 536-3500

NPI assigned

Oct 27, 2014

Last updated

Mar 24, 2025By 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 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Granger Medical Specialists LLC

  • Clinic/Center
  • West Valley City, UT
  • NPI 1376159368
  Medicare reassignment NPD
• Shriners Hospitals for Children

  • Pediatric Orthopaedic Surgery Physician
  • Shreveport, LA
  • NPI 1568803732
  NPD (past)

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

{
    "created_epoch": "1414368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742774400000",
    "number": "1609271188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1275 E FAIRFAX RD",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841034324",
            "telephone_number": "801-536-3500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1275 E FAIRFAX RD",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841034324",
            "telephone_number": "801-536-3500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1420 N Tracy Blvd",
            "address_purpose": "LOCATION",
            "city": "Tracy",
            "state": "CA",
            "postal_code": "953763451",
            "country_code": "US",
            "telephone_number": "209-832-6018",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9844 S 1300 E Ste 100",
            "address_purpose": "LOCATION",
            "city": "Sandy",
            "state": "UT",
            "postal_code": "840944600",
            "country_code": "US",
            "telephone_number": "801-571-9433",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3725 W 4100 S",
            "address_purpose": "LOCATION",
            "city": "West Valley City",
            "state": "UT",
            "postal_code": "841205530",
            "country_code": "US",
            "telephone_number": "801-965-3600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1420 N Tracy Blvd",
            "address_purpose": "LOCATION",
            "city": "Tracy",
            "state": "CA",
            "postal_code": "953763451",
            "country_code": "US",
            "telephone_number": "209-832-6018",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SUMNER",
        "first_name": "BENJAMIN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-10-27",
        "last_updated": "2025-03-24",
        "certification_date": "2025-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "52030",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephen James Summers, M.D.
• Summit Laser Medical Arts, LLC
• Summit Oral & Maxillofacial Surgery
• Summit Vitality Partners, PLLC (Evertitan)
• Shanna Summy, R.T.
• Jayne Ann Sumner, LCSW
• Rachel Sumner, RN
• Rachelle Sumner
• Sahara Shalee Sumner
• Susanna Ashley Sumner

• Physician Assistant in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2025; 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.