1. Home
  2. Directory
  3. Utah
  4. Grantsville
  5. Nurse Practitioner
  6. NPI Profile

GUNDERSEN FAMILY PRACTICE
NPI 1457002503
Nurse Practitioner in Grantsville, UT

Active since January 11, 2022CLIA 46D2257891 · Waiver
163 S SR 112 HWY UNIT 106, GRANTSVILLE, UT 84029(435) 264-4164(435) 264-4264 Get Directions Write a Review

NPPES record last updated: April 24, 2024. Verified against the NPPES registry weekly; last sync: November 08, 2026.

Record update history: Apr 24, 2024, Feb 25, 2022, Feb 18, 2022 and 2 more (5 updates tracked since 2022).

About Gundersen Family Practice NPPES

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

GUNDERSEN FAMILY PRACTICE (NPI 1457002503) is a healthcare organization registered as a nurse practitioner in Grantsville, Utah and active in the NPI registry since January 2022. The organization holds a CLIA Waiver certificate valid through April 11, 2028 and lists Shaun Gundersen, Owner, as its authorized official.

NPPES Registry Identity

NPI1457002503
Entity TypeOrganization
Primary Taxonomy363L00000X
Legal Business NameSHAUN GUNDERSEN FNP, PLLC
Location Address163 S SR 112 HWY UNIT 106Grantsville, UT 84029-5520
Mailing Address3976 Marshall RdGrantsville, UT 84029-9528
Phone(435) 264-4164
Fax(435) 264-4264
Organization SubpartNo
Authorized OfficialShaun GundersenOwner · (435) 840-5942
Enumeration DateJanuary 11, 2022
Last NPPES UpdateApril 24, 20245 updates tracked since enumeration
NPPES CertifiedApril 24, 2024
✔ NPI 1457002503 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
Definition
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
163 S SR 112 HWY UNIT 106, Grantsville, UT 84029
Open in Google Maps ↗

Other Names 1

Doing Business AsGundersen Family Practice

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Regence BlueCross BlueShield of Utah, University of Utah Health Plans.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Gundersen Family Practice is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

3

Medicare enrollment records show 3 clinicians reassign Medicare billing to Gundersen Family Practice, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.

Clinicians, nearest first (3)

Shaun Gundersen, DNP, APRN, FNP-C
Nurse Practitioner
NPI 1659721934
163 S SR 112 HWY STE 106
Grantsville, UT 84029
(435) 264-4164
✔ PECOS✔ Accepts MedicareSame address
Janelle Neu, APRN, FNP-C
Nurse Practitioner
NPI 1275326019
163 S SR 112 HWY STE 106
Grantsville, UT 84029
(435) 264-4164
✔ PECOS✔ Accepts MedicareSame address
Brooke Tuttle, MSN, APRN, FNP-C
Nurse Practitioner
NPI 1871014159
1900 N STATE ST
Provo, UT 84604
(801) 373-2001
✔ PECOS✔ Accepts Medicare46 mi

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

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 46D2257891

Gundersen Family Practice · Grantsville, UT
Active · expires Apr 11, 2028
CLIA Number46D2257891
Laboratory TypePhysician Office
Certificate Effective DateApril 12, 2026
Certificate Expiration DateApril 11, 2028
Laboratory DirectorShaun T. Gundersen
Laboratory Phone(435) 264-4164
Laboratory LocationGundersen Family Practice163 South Sr 112 Suite 106, Grantsville, UT 84029
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Shaun Gundersen Fnp, PLLC's NPI number?

The NPI number for Shaun Gundersen Fnp, PLLC is 1457002503. It was assigned to this organization in the NPPES registry on January 11, 2022. The provider is doing business as Gundersen Family Practice.

Where is Shaun Gundersen Fnp, PLLC located?

Shaun Gundersen Fnp, PLLC is located at 163 S Sr 112 Hwy Unit 106, Grantsville, UT 84029. The listed phone number is (435) 264-4164.

What is Shaun Gundersen Fnp, PLLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Is Shaun Gundersen Fnp, PLLC enrolled in Medicare?

Yes. Shaun Gundersen Fnp, PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Shaun Gundersen Fnp, PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Shaun Gundersen Fnp, PLLC. A 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 the clinician's services. Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Shaun Gundersen Fnp, PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 46D2257891) is associated with this NPI, valid through April 11, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Shaun Gundersen Fnp, PLLC accept?

Health plans from BridgeSpan Health Company, Regence BlueCross BlueShield of Utah and University of Utah Health Plans list Shaun Gundersen Fnp, PLLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Shaun Gundersen Fnp, PLLC was last updated on April 24, 2024. 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.