Unknown Individual – Obstetrics Physician, NPI 1669567376
Obstetrics Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
358 OBSTETRICS/GYNECOLOGY in UT
Provider Addresses for Unknown Individual
2965 W 3500 S
WEST VALLEY CITY, UT 841193602
Phone: (801) 965-3600
Type: Mailing
9600 S 1300 E STE 220
SANDY, UT 840943783
Phone: (801) 571-0009
Fax: (801) 576-1085
Type: Location
7181 S CAMPUS VIEW DR
WEST JORDAN, UT 840844312
Phone: (801) 965-3505
Type: Mailing
1300 East, Sage Crest Subdivision Number 5, Sandy, Salt Lake County, Utah, 84094, United States
SUITE 302
SANDY, UT 840943766
Phone: (801) 571-0009
Fax: (801) 576-1085
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 42 Open Payments records for all available years, with a total value of $909.
Total Amount is formed as General ($909) + Research ($0) + Ownership ($0) = $909.
Last reported payment date: 2024-12-10 • Largest payer in this snapshot: Astellas Pharma US Inc ($276).
Total Amount
$909
General + Research + Ownership
Payments
42
Total payment records
General Amount
$909
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-10
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Astellas Pharma US Inc | $276 |
| ABBVIE INC. | $232 |
| Currax Pharmaceuticals LLC | $80 |
| IDORSIA PHARMACEUTICALS US INC | $57 |
| MAYNE PHARMA COMMERCIAL LLC | $42 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2012-04-11
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20120411000649 | I | Obstetrics/Gynecology | UT | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| G0101 | Cervical or vaginal cancer screening; pelvic and clinical breast examination | 28 | 28 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 24 | 24 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 20 | 20 | $0 |
Insurance plans in this area (ZIP 84119)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | UT | |
| U R O L O G Y | UT | |
| - | UT | |
| Pain Management | UT | |
| Physician Assistant | UT | |
| - | UT | |
| Sports Medicine, Family Practice | UT | |
| - | UT | |
| Family Practice | UT | |
| Internal Medicine | UT |
Reviews
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