Mark Traveller Hansen (NPI# 1689646507, PAC ID# 7911193990) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is GENERAL SURGERY.
| Nation Provider ID (NPI) | 1689646507 |
| PAC ID by PECOS | 7911193990 |
| Professional Enrollment ID | I20101202000672 |
| Full Name | Mark Traveller Hansen |
| Organization Legal Name | MOUNTAINSTAR MEDICAL GROUP-CACHE VALLEY LLC |
| Address |
2380 N 400 Suite A North Logan UT 84341-1756 |
| Phone Number | 4357131300 |
| Gender | M |
| Medical School | UNIVERSITY OF UTAH SCHOOL OF MEDICINE |
| Graduation Year | 1993 |
| Primary Specialty | GENERAL SURGERY |
| Group Practice PAC ID | 5193887149 |
| Number of Group Practice Members | 7 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 460015 | LOGAN REGIONAL HOSPITAL |
| 460054 | CACHE VALLEY HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 2850 N 2000, Suite 101, Farr West, UT 84404-9264 | 8017311222 | MOUNTAINSTAR MEDICAL GROUP-CACHE VALLEY LLC |
| 2380 N 400, Suite A, North Logan, UT 84341-1756 | 4357131300 | MOUNTAINSTAR MEDICAL GROUP-CACHE VALLEY LLC |
| Organization Legal Name | MOUNTAINSTAR MEDICAL GROUP-CACHE VALLEY LLC |
| Physicians | 6 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Kevin R Duke | Family Medicine | Mountainstar Medical Group-cache Valley LLC | 382 W 280, Providence, UT 84332-9753 |
| Matthew J Welter | Family Medicine | Mountainstar Medical Group-cache Valley LLC | 2380 N 400, Suite A, North Logan, UT 84341-1756 |
| Richard Thomas Stevens | Family Medicine | Mountainstar Medical Group-cache Valley LLC | 382 W 280, Providence, UT 84332-9753 |
| Nathan R Bertoldo | Obstetrics/gynecology | Mountainstar Medical Group-cache Valley LLC | 2380 N 400, North Logan, UT 84321 |
| Lars Bergeson | Family Practice | Mountainstar Medical Group-cache Valley LLC | 382 W 280, Providence, UT 84332-9753 |
| Street Address |
2380 N 400 SUITE A |
| City | NORTH LOGAN |
| State | UT |
| Zip | 84341-1756 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Matthew J Welter | Family Medicine | Mountainstar Medical Group-cache Valley LLC | 2380 N 400, Suite A, North Logan, UT 84341-1756 |
| Ashley A Crum | Emergency Medicine | Emergency Physicians Integrated Care LLC | 2380 N 400, North Logan, UT 84341-6000 |
| Shay Holley | Emergency Medicine | Emergency Physicians Integrated Care LLC | 2380 N 400, North Logan, UT 84341-6000 |
| John Robert Meyers | Emergency Medicine | Emergency Physicians Integrated Care LLC | 2380 N 400, North Logan, UT 84341-6000 |
| Karen Lynn Taylor-fawcett | Nurse Practitioner | Santibanez Aguirre PC | 2380 N 400, North Logan, UT 84341-6000 |
| Nathalia Homolka Williams | Nurse Practitioner | Santibanez Aguirre PC | 2380 N 400, North Logan, UT 84341-6000 |
| Nathan R Bertoldo | Obstetrics/gynecology | Mountainstar Medical Group-cache Valley LLC | 2380 N 400, North Logan, UT 84321 |
| Alexander Stephen Swan | Emergency Medicine | Emergency Physicians Integrated Care LLC | 2380 N 400, North Logan, UT 84341-6000 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Danny E Spencer | Emergency Medicine | Sterling Physician Group Pllc | 1400 N 630 E, Suite 150, Logan, UT 84341 |
| Roger M Moczygemba | Emergency Medicine | Sterling Physician Group Pllc | 1400 N 630 E, Suite 150, Logan, UT 84341 |
| Robert P Young | Dermatology | Rocky Mountain Dermatology Inc | 1760 N 200, Suite 101, North Logan, UT 84341-1202 |
| Heather B Allred | Physician Assistant | Rocky Mountain Dermatology Inc | 1760 N 200, Suite 101, North Logan, UT 84341-1202 |
| Angela K Cronin | Physician Assistant | Rocky Mountain Dermatology Inc | 1760 N 200, Suite 101, North Logan, UT 84341-1202 |
| Scott Eric Macdonald | Physician Assistant | Rocky Mountain Dermatology Inc | 1760 N 200, Suite 101, North Logan, UT 84341-1202 |
| Christopher J Morgan | Nurse Practitioner | 2150 N Main St, Suite 10, North Logan, UT 84341-1740 | |
| Charles R Acevedo | Physical Therapy | Logan Physical Therapy PC | 2310 N 400 E C, North Logan, UT 84341-1743 |
| Jason Christiansen | Physical Therapy | Logan Physical Therapy PC | 2310 N 400 E C, North Logan, UT 84341-1743 |
| Ryan J Perry | Physical Therapy | Logan Physical Therapy PC | 2310 N 400 E C, North Logan, UT 84341-1743 |
| Find all physicians in zip 84341 | |||
| City | NORTH LOGAN |
| Zip Code | 84341 |
| Specialty | GENERAL SURGERY |
| City + Specialty | NORTH LOGAN + GENERAL SURGERY |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.