Individual provider Active NPI

Terri L. Anderson, PA-C

  • Surgical Physician Assistant
  • Eglin AFB, FL
National Provider Identifier
1902896848
Registry record updated Jun 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA 9107825 Issued in FL
Practice address
307 Boatner Rd Ste 114
Eglin AFB, FL 32542-1302
Phone
(850) 883-8345
NPI assigned
Oct 23, 2005
Last updated
Jun 12, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA 9107825 FL Primary

Addresses

Primary practice location

307 Boatner Rd Ste 114
Eglin AFB, FL 32542-1302

Mailing address

4038 Lauren CT
Destin, FL 32541-2127
Phone (850) 621-2447

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20181009002571 UT Practitioner - Physician Assistant 1355561382 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
Catholic Health Initiatives ColoradoGroup PAC ID 8022927342, 1,230 clinicians

Practice addresses (Care Compare)

3336 S 4155
West Valley City, UT 84120

82 S 1100
Suite 103
Salt Lake City, UT 84102-1889
Phone (801) 505-5370

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA 9107825FLMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Catholic Health Initiatives Colorado CurrentSince Jun 26, 2023 Accepting new patients
Physician Group of Utah Inc CurrentSince Sep 1, 2018 Accepting new patients
Catholic Health Initiatives Colorado CurrentSince Jun 26, 2023 Accepting new patients
Catholic Health Initiatives Colorado Past Accepting new patients

Locations

9100 E Mineral Cir
Centennial, CO 80112
Phone (303) 561-5193

6322 S 3000 E
Ste 140
Salt Lake City, UT 84121
Phone (801) 733-9924

82 S 1100 E
Ste 303
Salt Lake Cty, UT 84102
Phone (801) 533-2002

82 S 1100 E
Ste 103
Salt Lake Cty, UT 84102
Phone (801) 505-5370

2530 W 4700 S
Ste B8
Taylorsville, UT 84129
Phone (801) 967-5866

3584 W 9000 S
Ste 405
West Jordan, UT 84088
Phone (801) 568-3480

3580 W 90th S
West Jordan, UT 84088
Phone (801) 263-0810

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

Hospital & facility affiliations 1

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": "1130025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1434067200000",
    "number": "1902896848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4038 LAUREN CT",
            "city": "DESTIN",
            "state": "FL",
            "postal_code": "325412127",
            "telephone_number": "850-621-2447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 BOATNER RD STE 114",
            "city": "EGLIN AFB",
            "state": "FL",
            "postal_code": "325421302",
            "telephone_number": "850-883-8345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "TERRI",
        "middle_name": "L.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-23",
        "last_updated": "2015-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA 9107825",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eglin AFB, FL

Sources for this page

Verify at the official NPI Registry.