Active NPI
Kirk R Anderson, MD
- Internal Medicine Physician
- Provo, UT
National Provider Identifier
1801854021
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 1621571205
- Practice address
- 306 River Bend LN
Provo, UT 84604-5625 - Phone
- (801) 226-8880
- NPI assigned
- May 4, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 1621571205 | UT | Primary |
Addresses
Primary practice location
306 River Bend LN
Provo, UT 84604-5625
Mailing address
1055 N 500 W
Provo, UT 84604-3305
Phone (801) 429-8000
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0358 | Other | UT | DMBA |
| 04-00306 | Other | UT | UNITED HEALTHCARE |
| 870281028AN1 | Other | UT | EMIA |
| 110037852 | Other | UT | PALMETTO GBA |
| 14053 | Other | UT | PEHP |
| 870281028000 | Medicaid | UT | |
| 107006625101 | Other | UT | IHC HEALTHPLANS |
| QM0000000034 | Other | UT | ALTIUS |
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 |
|---|---|---|---|
| 1621571205 | UT | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Revere Health PC | Past | Accepting new patients |
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1263168000000",
"number": "1801854021",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1055 N 500 W",
"city": "PROVO",
"state": "UT",
"postal_code": "846043305",
"telephone_number": "801-429-8000",
"fax_number": "801-429-8150"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "306 RIVER BEND LN",
"city": "PROVO",
"state": "UT",
"postal_code": "846045625",
"telephone_number": "801-226-8880"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "KIRK",
"middle_name": "R",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-04",
"last_updated": "2010-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "UT",
"license": "1621571205",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DMBA",
"identifier": "0358",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "04-00306",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EMIA",
"identifier": "870281028AN1",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PALMETTO GBA",
"identifier": "110037852",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PEHP",
"identifier": "14053",
"state": "UT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "870281028000",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IHC HEALTHPLANS",
"identifier": "107006625101",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ALTIUS",
"identifier": "QM0000000034",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Provo, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.