Individual provider Active NPI

Shayne McQuivey, PA-C

  • Surgical Physician Assistant
  • Murray, UT
National Provider Identifier
1720199078
Registry record updated Sep 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
97-345479-1206 Issued in UT
Practice address
5848 Fashion Blvd
Murray, UT 84107-6121
Phone
(801) 314-4900
Fax
(801) 314-4919
NPI assigned
Aug 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 97-345479-1206 UT Primary

Addresses

Primary practice location

5848 Fashion Blvd
Murray, UT 84107-6121

Mailing address

5848 Fashion Blvd
Murray, UT 84107-6121
Phone (801) 314-4900

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
I20040331000799 UT Practitioner - Physician Assistant 2163414178 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Orthopedic Clinic LCGroup PAC ID 8527090729, 18 clinicians

Practice addresses (Care Compare)

11762 S State St
Suite 160
Draper, UT 84020-7174
Phone (801) 314-4195

5848 S Fashion Blvd
Suite 110
Salt Lake City, UT 84107-6175
Phone (801) 314-4188

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
97-345479-1206UTMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services, Inc. CurrentSince Apr 28, 2008 Accepting new patients
Ihc Health Services Inc CurrentSince Apr 28, 2008 Accepting new patients
Ihc Health Services Inc CurrentSince Jan 13, 2022 Accepting new patients
Ihc Health Services Inc Past Accepting new patients
Advanced Orthopedics & Sports Medicine Orthopaedic Surgery Past Accepting new patients

Locations

700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555

5848 S Fashion Blvd
Salt Lake Cty, UT 84107
Phone (801) 314-4040

5848 S Fashion Blvd
Ste 110
Salt Lake Cty, UT 84107
Phone (801) 314-4188

5121 S Cottonwood St
Salt Lake Cty, UT 84107
Phone (801) 408-8998

400 C St
Salt Lake Cty, UT 84143
Phone (435) 688-4080

Interoperability endpoints

  • Direct secure messaging: shayne.mcquivey.1@28271.direct.athenahealth.com

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346976000000",
    "number": "1720199078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5848 FASHION BLVD",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841076121",
            "telephone_number": "801-314-4900",
            "fax_number": "801-314-4919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5848 FASHION BLVD",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841076121",
            "telephone_number": "801-314-4900",
            "fax_number": "801-314-4919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCQUIVEY",
        "first_name": "SHAYNE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2012-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "UT",
            "license": "97-345479-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Murray, UT

Sources for this page

Verify at the official NPI Registry.