Active NPI
Andrea Kirstin Bacani, M.D.
- Rheumatology Physician
- Ogden, UT
National Provider Identifier
1730163239
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rheumatology Physician
- License
- 8027519-1205
- Practice address
- 4403 Harrison Blvd
Ste 3650
Ogden, UT 84403-3271 - Phone
- (801) 387-7125
- NPI assigned
- Nov 30, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 34524 | AZ | |
| Rheumatology Physician | 207RR0500X | 103872 | MN | |
| Rheumatology Physician | 207RR0500X | 51043 | MN | |
| Rheumatology Physician | 207RR0500X | 8027519-1205 | UT | Primary |
Addresses
Primary practice location
4403 Harrison Blvd
Ste 3650
Ogden, UT 84403-3271
Mailing address
PO Box 27128
Salt Lake City, UT 84127-0128
Phone (801) 387-7125
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 223832 | Medicaid | AZ | |
| P00728951 | Other | MN | RAILROAD MEDICARE |
| ENROLLED | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 103872 | MN | MD | Rheumatology Physician |
| 51043 | MN | MD | Rheumatology Physician |
| 8027519-1205 | UT | MD | Rheumatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133308800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314748800000",
"number": "1730163239",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 27128",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841270128",
"telephone_number": "801-387-7125"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4403 HARRISON BLVD",
"address_2": "STE 3650",
"city": "OGDEN",
"state": "UT",
"postal_code": "844033271",
"telephone_number": "801-387-7125"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BACANI",
"first_name": "ANDREA",
"middle_name": "KIRSTIN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-11-30",
"last_updated": "2011-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "AZ",
"license": "34524",
"primary": false
},
{
"code": "207RR0500X",
"taxonomy_group": "",
"desc": "Internal Medicine, Rheumatology",
"state": "MN",
"license": "103872",
"primary": false
},
{
"code": "207RR0500X",
"taxonomy_group": "",
"desc": "Internal Medicine, Rheumatology",
"state": "MN",
"license": "51043",
"primary": false
},
{
"code": "207RR0500X",
"taxonomy_group": "",
"desc": "Internal Medicine, Rheumatology",
"state": "UT",
"license": "8027519-1205",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "223832",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00728951",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "ENROLLED",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ogden, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.