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MARK C SANDERSON MD
NPI 1073604609
Surgery - Plastic and Reconstructive Surgery in American Fork, UT

Active since September 27, 2006PECOS Enrolled
1184 E 80 N, AMERICAN FORK, UT 84003(801) 763-3885(801) 763-3887 Get Directions Write a Review

NPPES record last updated: November 27, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jan 30, 2020, Nov 26, 2018 (2 updates tracked since 2018).

About Mark C Sanderson Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARK C SANDERSON MD (NPI 1073604609) is an individual plastic and reconstructive surgery provider in American Fork, Utah, licensed in Utah (187115-1205) and active in the NPI registry since September 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1073604609
Entity TypeIndividualMale
Primary Taxonomy2086S0122X
Provider Legal NameMARK C SANDERSONCredential: MD
Location Address1184 E 80 NAmerican Fork, UT 84003-2906
Mailing Address1055 N 500 W, Credentialing DepartmentProvo, UT 84604-3305 · (801) 354-8225 · Fax (801) 418-0941
Phone(801) 763-3885
Fax(801) 763-3887
Sole ProprietorNo
Enumeration DateSeptember 27, 2006
Last NPPES UpdateNovember 27, 20232 updates tracked since enumeration
NPPES CertifiedJanuary 30, 2020
✔ NPI 1073604609 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtySurgery · Plastic and Reconstructive SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code2086S0122X
License✔ Licensed in UT · 187115-1205
Definition
A surgeon who specializes in plastic and reconstructive surgery.
Also ListedOrthopaedic Surgery · Hand SurgeryTaxonomy 207XS0106X · License 187115-1205 (UT)
Also ListedPlastic Surgery · Surgery of the HandTaxonomy 2082S0105X · License 187115-1205 (UT)
1184 E 80 N, American Fork, UT 84003
Open in Google Maps ↗

Other Identifiers 8

Other107005288103UT · Ihc
Other13-00081UT · United Healthcare
Other215832UT · Altius
Other54270UT · Dmba
Other870281028SANUT · Emia
Other79371UT · Pehp
Medicaid870281028000UT
OtherP00167990UT · Palmetto

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mark C Sanderson Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Mark Sanderson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Revere Health PC
7.0 mi
Multi-Specialty
1055 N 500 W
Provo, UT 84604
  • Reassigned Medicare billing, Utah enrollment
  • 414 clinicians in this Medicare group
NPI 1093764805 (801) 429-8000

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 16

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

HUMAN PERFORMANCE INSTITUTE PC
Clinic/Center (Physical Therapy)
1184 E 80 N
AMERICAN FORK, UT 84003
Utah County (801) 756-7777
ANDREW BENJAMIN WARD PA
Physician Assistant
1184 E 80 N
AMERICAN FORK, UT 84003
Utah County (801) 763-3885
RUSSELL JACK GATENBY PT
Physical Therapist
1184 E 80 N
AMERICAN FORK, UT 84003
Utah County (801) 756-7777
CENTRAL UTAH CLINIC, P.C.
Orthopaedic Surgery
1184 E 80 N
AMERICAN FORK, UT 84003
Utah County (801) 763-3885
ROBERT TODD SUMPTER PA-C
Physician Assistant
1184 E 80 N
AMERICAN FORK, UT 84003
Utah County (801) 763-3885
SALT LAKE ORTHOPAEDIC SPECIALIST, LLC
Podiatrist (Foot & Ankle Surgery)
1184 E 80 N
AMERICAN FORK, UT 84003
Utah County (801) 763-3885
KENDRA ANN PARKER
Physician Assistant (Surgical)
1184 E 80 N
AMERICAN FORK, UT 84003
Utah County (801) 763-3885
MR. CHRISTOPHER JAY WILCOX PA
Physician Assistant
1184 E 80 N
AMERICAN FORK, UT 84003
Utah County (801) 763-3385

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mark Sanderson's NPI number?

The NPI number for Mark Sanderson is 1073604609. It was assigned to this individual provider in the NPPES registry on September 27, 2006.

Where is Mark Sanderson located?

Mark Sanderson practices at 1184 E 80 N, American Fork, UT 84003. The listed phone number is (801) 763-3885.

What is Mark Sanderson's specialty?

The primary specialty registered for this NPI is Surgery, specializing in Plastic and Reconstructive Surgery, with taxonomy code 2086S0122X.

Is Mark Sanderson enrolled in Medicare?

Yes. Mark Sanderson is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Mark Sanderson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Mark Sanderson reassigns Medicare benefits to Revere Health PC (Provo, UT). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Mark Sanderson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Mark Sanderson was last updated on November 27, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.