JEFFERY W ANDERSON, PA — NPI 1255398921 (Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers

CMS-1500 Box 24J / 33a • NPI

1255398921

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

363AM0700X (CMS 97)

Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant, Medical

Box 32 Service Location & ZIP+4

5640 S 3500 W, ROY, UT, 84067-9158

✓ 9-Digit EDI 837 ZIP+4 (84067-9158)

Practice Phone & Referral Fax

(801) 773-2838

Fax: (801) 773-3025

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1255398921 (JEFFERY W ANDERSON, PA) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1255398921` (NPI-1 Individual Practitioner)
Provider / Legal Name	JEFFERY W ANDERSON, PA
Plain-English Specialty	Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant, Medical NUCC Code: `363AM0700X` (Physician Assistant, Medical)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	5640 S 3500 W, ROY, UT, 84067-9158
Practice Telephone / Fax	Tel: (801) 773-2838 \| Fax: (801) 773-3025
Administrative Mailing Address	1055 N 500 W, PROVO, UT, 84604-3305
Enumeration & Last Sync	Enumerated: 2006-04-27 \| CMS Record Updated: 2023-11-27

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

5640 S 3500 W, ROY, UT, 84067-9158

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Plain-English Taxonomy & CMS Crosswalk (363AM0700X)

What Does Taxonomy Code 363AM0700X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363AM0700X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant, Medical"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 97 (Physician Assistant)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Physician Assistant, Medical for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (JEFFERY W ANDERSON, PA)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`363AM0700X` — Physician Assistant, Medical Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant, Medical	State: UT \| License: `325314-1206` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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JEFFERY W ANDERSON, PA (NPI #1255398921)