Individual provider Active NPI

Sage Nyman, PA

  • Physician Assistant
  • Logan, UT
National Provider Identifier
1770156820
Registry record updated Nov 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
12605348-1206 Issued in UT
Practice address
412 N 200 E
Logan, UT 84321-4038
Phone
(435) 713-2850
NPI assigned
Jul 16, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 12605348-1206 UT Primary

Addresses

Primary practice location

412 N 200 E
Logan, UT 84321-4038

Mailing address

PO Box 27128
Salt Lake City, UT 84127-0128

Other practice location 1

4460 S Highland Dr
Salt Lake City, UT 84124-3543
Phone (888) 949-4864

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Bluemark LLC/ Office Ally

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
I20220106001767 UT Practitioner - Physician Assistant 4486045127 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Valley Behavioral Health IncorporatedGroup PAC ID 0042121196, 84 clinicians

Practice addresses (Care Compare)

1020 S Main St
Salt Lake City, UT 84101-3176
Phone (801) 539-7000

4460 S Highland Dr
Salt Lake City, UT 84124-3550

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Tecs Utah PC CurrentSince Sep 1, 2025 Accepting new patients
Valley Behavioral Health Incorporated CurrentSince Dec 14, 2021 Accepting new patients

Locations

18312 Middlebelt Rd
Livonia, MI 48152
Phone (248) 426-9944

350 E 300 N
American Fork, UT 84003
Phone (385) 350-8500

523 N Main St
Bountiful, UT 84010
Phone (801) 951-1600

775 N 200 E
Brigham City, UT 84302
Phone (435) 723-7777

1100 N 400 E
Nephi, UT 84648
Phone (435) 623-1721

163 E 1000 N
Richfield, UT 84701
Phone (435) 896-8211

4460 S Highland Dr
Slc, UT 84124
Phone (801) 263-7101

4460 S Highland Dr
Ste 230
Slc, UT 84124
Phone (801) 263-7227

1020 S Main St
Slc, UT 84101
Phone (801) 536-6500

2472 S 300 E
South Salt Lake, UT 84115
Phone (801) 273-6402

Organizations & group practices 2

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": "1626393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763683200000",
    "number": "1770156820",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 N 200 E",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843214038",
            "telephone_number": "435-713-2850"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4460 S Highland Dr",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841243543",
            "country_code": "US",
            "telephone_number": "888-949-4864",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NYMAN",
        "first_name": "SAGE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-16",
        "last_updated": "2025-11-21",
        "certification_date": "2025-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "12605348-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.3",
            "affiliationName": "Bluemark LLC/ Office Ally",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "1300 SE Cardinal Ct Ste 190",
            "city": "Vancouver",
            "state": "WA",
            "country_code": "US",
            "postal_code": "986839683",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Logan, UT

Sources for this page

Verify at the official NPI Registry.