Individual provider Active NPI

Cameron D Anderson, M.D.

  • Obstetrics & Gynecology Physician
  • Payson, UT
National Provider Identifier
1629096870
Registry record updated Aug 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
361821-1205 Issued in UT
Practice address
39 Professional Way
Suite 4
Payson, UT 84651-1675
Phone
(801) 465-3201
Fax
(801) 465-2889
NPI assigned
Jul 17, 2006
Last updated
Aug 20, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 361821-1205 UT Primary

Addresses

Primary practice location

39 Professional Way
Suite 4
Payson, UT 84651-1675

Mailing address

39 Professional Way
Suite 4
Payson, UT 84651-1675
Phone (801) 465-3201

Other identifiers 1

IdentifierTypeStateIssuer
D2677MedicaidUT

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070416000412 UT Practitioner - Obstetrics/Gynecology 6709981020 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
361821-1205UTMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Valley Obstetrics and Gynecology, PC Obstetrics & Gynecology CurrentSince Jul 1, 2021 Accepting new patients

Locations

585 N 500 W
Provo, UT 84601
Phone (801) 374-1801

Organizations & group practices 1

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": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376956800000",
    "number": "1629096870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 PROFESSIONAL WAY",
            "address_2": "SUITE 4",
            "city": "PAYSON",
            "state": "UT",
            "postal_code": "846511675",
            "telephone_number": "801-465-3201",
            "fax_number": "801-465-2889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 PROFESSIONAL WAY",
            "address_2": "SUITE 4",
            "city": "PAYSON",
            "state": "UT",
            "postal_code": "846511675",
            "telephone_number": "801-465-3201",
            "fax_number": "801-465-2889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "CAMERON",
        "middle_name": "D",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2013-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "UT",
            "license": "361821-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D2677",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Payson, UT

Sources for this page

Verify at the official NPI Registry.