NPIMap

Individual provider Active NPI

Kevin Mark Anderson, PA-C

  • Medical Physician Assistant
  • Ogden, UT
National Provider Identifier
1831826759
Registry record updated Feb 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
9717755-1206 Issued in UT
Practice address
4403 Harrison Blvd Ste 3815
Ogden, UT 84403-3330
Phone
(801) 387-5620
NPI assigned
Aug 2, 2022
Last updated
Feb 6, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 9717755-1206 UT Primary

Addresses

Primary practice location

4403 Harrison Blvd Ste 3815
Ogden, UT 84403-3330

Mailing address

PO Box 27128
Salt Lake City, UT 84127-0128
Phone (801) 387-5620

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL kevin.anderson@rm.edu

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
I20230216000086 UT Practitioner - Physician Assistant 5294107439 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ihc Health Services IncGroup PAC ID 1850209420, shared by 68 NPIs, 3,948 clinicians

Practice addresses (Care Compare)

1380 E Medical Ctr Dr
St George, UT 84790-2123

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services, Inc. CurrentSince Nov 8, 2022 Accepting new patients
Ihc Health Services Inc CurrentSince Nov 8, 2022 Accepting new patients
Ihc Health Services Inc CurrentSince Nov 13, 2022 Accepting new patients
Ihc Health Services Inc CurrentSince Dec 2, 2024 Accepting new patients

Locations

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

4403 Harrison Blvd
Ste 3815
Ogden, UT 84403
Phone (801) 387-2575

5295 S Commerce Dr
Ste 550
Salt Lake City, UT 84107
Phone (801) 313-4110

1380 E Medical Center Dr
St George, UT 84790
Phone (435) 251-2992

1380 E Medical Center Dr
#P
St George, UT 84790
Phone (435) 251-2355

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1659398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675641600000",
    "number": "1831826759",
    "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": "801-387-5620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4403 HARRISON BLVD STE 3815",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844033330",
            "telephone_number": "801-387-5620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "KEVIN",
        "middle_name": "MARK",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-02",
        "last_updated": "2023-02-06",
        "certification_date": "2023-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "UT",
            "license": "9717755-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "kevin.anderson@rm.edu",
            "affiliation": "N",
            "address_1": "2075 N Main St Apt B106",
            "city": "Layton",
            "state": "UT",
            "country_code": "US",
            "postal_code": "840414981",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Ogden, UT

Sources for this page

Verify at the official NPI Registry.