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KALYANI SAMUDRA MD
NPI 1528035748
Psychiatry & Neurology - Child & Adolescent Psychiatry in Salt Lake City, UT

Active since March 07, 2006PECOS Enrolled
501 S CHIPETA WAY, ARTEC SOUTH CAMPUS, SECOND FLOOR, SALT LAKE CITY, UT 84108(801) 585-1575(801) 569-9718 Get Directions Write a Review

NPPES record last updated: November 17, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Kalyani Samudra Md NPPES

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

KALYANI SAMUDRA MD (NPI 1528035748) is an individual child & adolescent psychiatry provider in Salt Lake City, Utah, licensed in Utah (6079971-1205) and active in the NPI registry since March 2006. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1528035748
Entity TypeIndividualFemale
Primary Taxonomy2084P0804X
Provider Legal NameKALYANI SAMUDRACredential: MD
Location Address501 S CHIPETA WAY, ARTEC SOUTH CAMPUS, SECOND FLOORSalt Lake City, UT 84108-1222
Mailing AddressPo Box 413076Salt Lake City, UT 84141-3076 · (801) 213-3900 · Fax (801) 569-9718
Phone(801) 585-1575
Fax(801) 569-9718
Sole ProprietorNo
Enumeration DateMarch 7, 2006
Last NPPES UpdateNovember 17, 2021
NPPES CertifiedNovember 17, 2021
✔ NPI 1528035748 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPsychiatry & Neurology · Child & Adolescent PsychiatryAllopathic & Osteopathic Physicians
Taxonomy Code2084P0804X
License✔ Licensed in UT · 6079971-1205
Definition
Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence.
Also ListedPsychiatry & Neurology · PsychiatryTaxonomy 2084P0800X · License 6079971-1205 (UT)
501 S CHIPETA WAY, Salt Lake City, UT 84108
Open in Google Maps ↗

Other Identifiers 1

Other60799711200001UT · Blue Cross Provider #

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Molina Healthcare, Regence BlueCross BlueShield of Utah and more.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kalyani Samudra 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 Reassignments

4

Medicare enrollment records show Kalyani Samudra reassigns Medicare billing to 4 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

University Of Utah Acuity Care Services
Same address
Neuromuscular Medicine
501 S CHIPETA WAY
Salt Lake City, UT 84108
  • Reassigned Medicare billing, Utah enrollment
  • 338 clinicians in this Medicare group
NPI 1366804254 (801) 587-6336
University Of Utah Behavioral Health Services
Same address
Psychiatry
501 S CHIPETA WAY
Salt Lake City, UT 84108
  • Reassigned Medicare billing, Utah enrollment
  • 295 clinicians in this Medicare group
NPI 1093265654 (801) 585-1575
University Of Utah Pediatric Acuity Care
Same address
Neuromuscular Medicine
501 S CHIPETA WAY
Salt Lake City, UT 84108
  • Reassigned Medicare billing, Utah enrollment
  • 202 clinicians in this Medicare group
NPI 1558723445 (801) 587-6336
University Of Utah Pediatric Behavioral Health Services
Same address
Child & Adolescent Psychiatry
501 S CHIPETA WAY
Salt Lake City, UT 84108
  • Reassigned Medicare billing, Utah enrollment
  • 111 clinicians in this Medicare group
NPI 1205378320 (801) 587-6336

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 20

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

DR. ERIC THAYNE MONSON MD, PHD
Psychiatry & Neurology (Psychiatry)
501 S CHIPETA WAY
SALT LAKE CITY, UT 84108
Salt Lake County (801) 581-4096
KATRIEL TAN
Student in an Organized Health Care Education/Training Program
501 S CHIPETA WAY
SALT LAKE CITY, UT 84108
Salt Lake County (516) 497-0340
UNIVERSITY OF UTAH PEDIATRIC BEHAVIORAL HEALTH SERVICES
Clinic/Center (Adolescent and Children Mental Health)
501 S CHIPETA WAY
SALT LAKE CITY, UT 84108
Salt Lake County (801) 587-6336
DR. AMY GALLOP WEAGLEY MD
Psychiatry & Neurology (Child & Adolescent Psychiatry)
501 S CHIPETA WAY
SALT LAKE CITY, UT 84108
Salt Lake County (801) 581-2121
ATIYA S NASH
Counselor (Mental Health)
501 S CHIPETA WAY
SALT LAKE CITY, UT 84108
Salt Lake County (801) 587-3000
VALERIE ELIZABETH SHAY MD
Psychiatry & Neurology (Psychiatry)
501 S CHIPETA WAY
SALT LAKE CITY, UT 84108
Salt Lake County (801) 581-7951
MAUREEN SIMES
Registered Nurse
501 S CHIPETA WAY
SALT LAKE CITY, UT 84108
Salt Lake County (801) 583-2500
JENNIFER HARMON
Counselor (Mental Health)
501 S CHIPETA WAY
SALT LAKE CITY, UT 84108
Salt Lake County (801) 587-2460

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 Kalyani Samudra's NPI number?

The NPI number for Kalyani Samudra is 1528035748. It was assigned to this individual provider in the NPPES registry on March 7, 2006.

Where is Kalyani Samudra located?

Kalyani Samudra practices at 501 S Chipeta Way Artec South Campus, Second Floor, Salt Lake City, UT 84108. The listed phone number is (801) 585-1575.

What is Kalyani Samudra's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Child & Adolescent Psychiatry, with taxonomy code 2084P0804X.

Is Kalyani Samudra enrolled in Medicare?

Yes. Kalyani Samudra is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Kalyani Samudra's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kalyani Samudra reassigns Medicare benefits to 4 organizations: University Of Utah Acuity Care Services (Salt Lake City, UT), University Of Utah Behavioral Health Services (Salt Lake City, UT), University Of Utah Pediatric Acuity Care (Salt Lake City, UT) and University Of Utah Pediatric Behavioral Health Services (Salt Lake City, UT). Each 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 Kalyani Samudra's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Kalyani Samudra accept?

Health plans from BridgeSpan Health Company, Molina Healthcare, Regence BlueCross BlueShield of Utah and Select Health list Kalyani Samudra 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 Kalyani Samudra was last updated on November 17, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.