NPIMap

Individual provider Active NPI

Carolyn Marion Anderson-Hansen, PA

  • Physician Assistant
  • Lehi, UT
National Provider Identifier
1861584963
Registry record updated Dec 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
9076173-1206 Issued in UT
Practice address
3000 N Triumph Blvd Ste 330
Lehi, UT 84043-7188
Phone
(385) 345-3560
NPI assigned
Sep 28, 2006
Last updated
Dec 11, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 11, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 4034 GA
Physician AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 363A00000X 9076173-1206 UT Primary

Addresses

Primary practice location

3000 N Triumph Blvd Ste 330
Lehi, UT 84043-7188

Mailing address

3000 N Triumph Blvd Ste 330
Lehi, UT 84043-7188
Phone (385) 345-3560

Other practice location 1

1034 N 500 W
Provo, UT 84604-3380
Phone (801) 357-7850

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
I20141104000028 UT Practitioner - Physician Assistant 9436042694 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Summit Brain and Spine PCGroup PAC ID 2365877917, 11 clinicians

Practice addresses (Care Compare)

3000 N Triumph Blvd
Suite 330
Lehi, UT 84043-7188
Phone (385) 345-3560

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
68.66 of 100Reported as group
Quality
50.22
Improvement activities
40
Cost
61.92

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4034GAMDPhysician Assistant

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733875200000",
    "number": "1861584963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 N TRIUMPH BLVD STE 330",
            "city": "LEHI",
            "state": "UT",
            "postal_code": "840437188",
            "telephone_number": "385-345-3560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 N TRIUMPH BLVD STE 330",
            "city": "LEHI",
            "state": "UT",
            "postal_code": "840437188",
            "telephone_number": "385-345-3560"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1034 N 500 W",
            "address_purpose": "LOCATION",
            "city": "Provo",
            "state": "UT",
            "postal_code": "846043380",
            "country_code": "US",
            "telephone_number": "801-357-7850",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANDERSON-HANSEN",
        "first_name": "CAROLYN",
        "middle_name": "MARION",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-28",
        "last_updated": "2024-12-11",
        "certification_date": "2024-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "4034",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "9076173-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lehi, UT

Sources for this page

Verify at the official NPI Registry.