NPIMap

Organization Active NPI

Santibanez Pac Utah

  • Geriatric Medicine (Internal Medicine) Physician
  • Salt Lake City, UT
National Provider Identifier
1881469484
Registry record updated Aug 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
Legal business name
SANTIBANEZ PAC UTAH
Practice address
451 E Bishop Federal LN
Salt Lake City, UT 84115-2357
Phone
(801) 487-7557
NPI assigned
Nov 24, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2026

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

Authorized official

Name
Julie Roser
Title
VP of Operations
Phone
(775) 222-0045

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0300X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

451 E Bishop Federal LN
Salt Lake City, UT 84115-2357

Mailing address

400 E Rivulon Blvd Ste 103
Gilbert, AZ 85297-0096
Phone (888) 408-7008

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240216000756 UT Part B Supplier - Clinic/Group Practice 1355785437 Receives reassigned benefits from 63 practitioners
Practice locations: Orem, UT; Pleasant Grove, UT; Richfield, UT; Salt Lake City, UT; South Jordan, UT; South Salt Lake, UT; Springville, UT; Taylorsville, UT…

National Provider Directory

National Provider Directory

Locations

4782 S Holladay Blvd
Salt Lake Cty, UT 84117
Phone (801) 277-7002

1497 E Skyline Dr
South Ogden, UT 84405
Phone (801) 689-1600

Practitioners & affiliated clinicians

Practitioners 64

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 64

NPI Registry JSON

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

{
    "created_epoch": "1700784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786320000000",
    "number": "1881469484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E RIVULON BLVD STE 103",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852970096",
            "telephone_number": "888-408-7008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "451 E BISHOP FEDERAL LN",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841152357",
            "telephone_number": "801-487-7557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTIBANEZ PAC UTAH",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-24",
        "last_updated": "2026-08-10",
        "certification_date": "2026-08-10",
        "status": "A",
        "authorized_official_last_name": "ROSER",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "775-222-0045"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.