NPIMap

Individual provider Active NPI

Connie Teteberg, PA

  • Physician Assistant
  • West Valley City, UT
National Provider Identifier
1801858923
Registry record updated Jan 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5153573-1206 Issued in UT
Practice address
3460 Pioneer Pkwy
West Valley City, UT 84120-2049
Phone
(801) 964-3100
NPI assigned
Apr 4, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2023

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 5153573-1206 UT Primary

Addresses

Primary practice location

3460 Pioneer Pkwy
West Valley City, UT 84120-2049

Mailing address

370 E South Temple
Ste 260
Salt Lake City, UT 84111-1206

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address CTETEBERG612473@DIRECT.MED.UTAH.EDU Direct University of Utah

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060202000408 UT Practitioner - Physician Assistant 7911911532 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Utah Community Physicians GroupGroup PAC ID 9739403569, 277 clinicians

Practice addresses (Care Compare)

1525 W 2100
Salt Lake City, UT 84119-1407
Phone (801) 213-9900

Hospital & facility affiliations

  • University of Utah Hospital and Clinics Hospital, Salt Lake City, UT, CCN 460009

Merit-based Incentive Payment System (MIPS)

Final score
89.01 of 100Reported as group
Quality
94.06
Promoting interoperability
100
Improvement activities
40
Cost
69.32

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1357COMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Community Physicians Group CurrentSince Nov 1, 2022 Accepting new patients
University of Utah Community Physicians Group CurrentSince Nov 1, 2022 Accepting new patients
University of Utah Community Physicians Group Past Accepting new patients
Elane Shirar MD Inc PastSince Nov 1, 1999 Accepting new patients

Locations

7495 S State St
Midvale, UT 84047
Phone (801) 213-9400

1743 Redstone Center Dr
Ste 115
Park City, UT 84098
Phone (435) 658-9200

1525 W 2100 S
Salt Lake City, UT 84119
Phone (801) 213-8841

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

5126 W Daybreak Pkwy
Ste 600
South Jordan, UT 84009

220 Millpond
Ste 100
Tooele, UT 84074
Phone (435) 843-3000

Interoperability endpoints

  • Direct secure messaging: cteteberg612473@direct.med.utah.edu

Organizations & group practices 5

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1144108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673136000000",
    "number": "1801858923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "370 E SOUTH TEMPLE",
            "address_2": "STE 260",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841111206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3460 PIONEER PKWY",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841202049",
            "telephone_number": "801-964-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TETEBERG",
        "first_name": "CONNIE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-04",
        "last_updated": "2023-01-08",
        "certification_date": "2023-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "5153573-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "CTETEBERG612473@DIRECT.MED.UTAH.EDU",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in West Valley City, UT

Sources for this page

Verify at the official NPI Registry.