Tandy Muse, PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

11281903-1206 Issued in UT

Practice address

4460 S Highland Dr Ste 400
Salt Lake City, UT 84124-3565

Phone

(801) 272-4111

Fax

(801) 272-5989

NPI assigned

Apr 30, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Advanced Spine and Pain PLLC

  • Pain Medicine (Anesthesiology) Physician
  • Draper, UT
  • NPI 1437627080
  Medicare reassignment

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

{
    "created_epoch": "1556582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601424000000",
    "number": "1841854338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4460 S HIGHLAND DR STE 400",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841243565",
            "telephone_number": "801-272-4111",
            "fax_number": "801-272-5989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4460 S HIGHLAND DR STE 400",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841243565",
            "telephone_number": "801-272-4111",
            "fax_number": "801-272-5989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUSE",
        "first_name": "TANDY",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-04-30",
        "last_updated": "2020-09-30",
        "certification_date": "2020-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "11281903-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ilakya Murugan
• Anthony G Musci, MD
• Derrick David Muse, M.D.
• Gregrey L Muse, DDS
• Marissa Muse
• Musely Compounding Pharmacy LLC (Musely)
• Amy L Musgrave
• Kylr L Musich, MSW, LCSW
• Brenda Lynn Mussells, RD
• Sariah Musser

• Family Medicine Physician in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Family Medicine Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.