1. Home
  2. Directory
  3. Utah
  4. American Fork
  5. Intermediate Care Facility Mental Illness
  6. NPI Profile

UTAH STATE DEVELOPMENTAL CENTER
NPI 1689674301
Intermediate Care Facility, Mental Illness in American Fork, UT

Active since July 22, 2005CLIA 46D0683172 · Microscopy
895 N. 900 E., AMERICAN FORK, UT 84003(801) 763-4000(801) 763-4073 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Utah State Developmental Center NPPES

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

UTAH STATE DEVELOPMENTAL CENTER (NPI 1689674301) is a healthcare organization registered as an intermediate care facility, mental illness in American Fork, Utah and active in the NPI registry since July 2005. The organization holds a CLIA Microscopy certificate valid through September 3, 2027 and lists Karen Clarke, Superintendent, as its authorized official.

NPPES Registry Identity

NPI1689674301
Entity TypeOrganization
Primary Taxonomy310500000X
Legal Business NameUTAH STATE DEVELOPMENTAL CENTER
Location Address895 N. 900 E.American Fork, UT 84003-9199
Mailing Address895 N. 900 E.American Fork, UT 84003-9199 · (801) 763-4000 · Fax (801) 763-4073
Phone(801) 763-4000
Fax(801) 763-4073
Organization SubpartNo
Authorized OfficialKaren ClarkeSuperintendent · (801) 763-4091
Enumeration DateJuly 22, 2005
Last NPPES UpdateAugust 22, 2020
✔ NPI 1689674301 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyIntermediate Care Facility, Mental IllnessNursing & Custodial Care Facilities
Taxonomy Code310500000X
License✔ Licensed in UT · 2004-NCF-95
Definition
A nursing facility that provides an intermediate level of nursing care to individuals whose functional abilities are significantly compromise by mental illness.
895 N. 900 E., American Fork, UT 84003
Open in Google Maps ↗

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Utah State Developmental Center is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

84

Medicare enrollment records show 84 clinicians reassign Medicare billing to Utah State Developmental Center, which bills Medicare for the services they deliver. Of these, 5 practice at this address and 10 within 10 miles. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 9

Clinical Social Worker27
Psychiatry14
Clinical Psychologist13
Nurse Practitioner13
Family Practice9
General Practice3
Podiatry3
Dentist1
1 other specialty1

Nearest to this location (20)

See all 84
Joseph Cook, MD
Family Practice
NPI 1831384452
895 N 900 E
American Fork, UT 84003
(801) 763-4201
✔ PECOSSame address
Steven Mickelson, F.N.P.
Nurse Practitioner
NPI 1881696466
895 N 900 E
American Fork, UT 84003
(801) 763-4152
✔ PECOS✔ Accepts MedicareSame address
Steven Monson, M.D.
Family Practice
NPI 1487090502
895 N 900 E
American Fork, UT 84003
(801) 763-4000
✔ PECOSSame address
Pamela Poulsen, DNP, FNP-C
Nurse Practitioner
NPI 1336524107
895 N 900 E
American Fork, UT 84003
(801) 322-4000
✔ PECOSSame address
Julie Powers, NP
Nurse Practitioner
NPI 1457991200
895 N 900 E
American Fork, UT 84003
(801) 763-4000
✔ PECOS✔ Accepts MedicareSame address
John Anderson, DDS
Dentist
NPI 1831106004
170 N CENTER ST
American Fork, UT 84003
(801) 756-2341
✔ PECOS1.1 mi
Mark Rogers, D.P.M.
Podiatry
NPI 1619958345
1248 E 90 N STE 101
American Fork, UT 84003
(801) 756-4200
✔ PECOS✔ Accepts Medicare1.2 mi
Scott Rogers, DPM
Podiatry
NPI 1821046418
1248 E 90 N STE 101
American Fork, UT 84003
(801) 756-4200
✔ PECOS✔ Accepts Medicare1.2 mi
Thomas Rayner, MD
Psychiatry
NPI 1194008979
1221 S VALLEY GROVE WAY STE 160
Pleasant Grove, UT 84062
(801) 447-7189
✔ PECOS✔ Accepts Medicare3.9 mi
Sandra Miller, APRN
Nurse Practitioner
NPI 1437105269
252 W KESTREL DRIVE
Saratoga Springs, UT 84045
(801) 756-3511
✔ PECOS8.1 mi
Brent Griffin, MD
Psychiatry
NPI 1023038114
1034 N 500 W
Provo, UT 84604
(801) 357-4542
✔ PECOS✔ Accepts Medicare12 mi
Thomas Rogers, D.P.M.
Podiatry
NPI 1720069446
150 W 800 N
Provo, UT 84601
(801) 375-5353
✔ PECOS✔ Accepts Medicare13 mi
Thomas Yee, APRN
Nurse Practitioner
NPI 1659456754
750 N FREEDOM BLVD STE 300
Provo, UT 84601
(801) 373-4760
✔ PECOS✔ Accepts Medicare13 mi
Alisa Erickson
Clinical Social Worker
NPI 1851604276
750 N FREEDOM BLVD
Provo, UT 84601
(801) 373-4760
✔ PECOS✔ Accepts Medicare13 mi
Joseph Miner, MD
Family Practice
NPI 1881652980
151 S UNIVERSITY AVE SUITE 2800
Provo, UT 84601
(801) 851-7011
✔ PECOS13 mi
Ted Barratt, PH.D.
Clinical Psychologist
NPI 1427184878
1300 E CENTER ST
Provo, UT 84606
(801) 344-4215
✔ PECOS14 mi
Michael Bartlett
Clinical Social Worker
NPI 1447507801
1300 E CENTER ST
Provo, UT 84606
(801) 344-4400
✔ PECOS✔ Accepts Medicare14 mi
John Bench, M.D.
Psychiatry
NPI 1114905965
1300 E CENTER ST
Provo, UT 84606
(801) 344-4400
✔ PECOS✔ Accepts Medicare14 mi
Douglas Benson, PSY.D
Clinical Psychologist
NPI 1306080544
1300 E CENTER ST
Provo, UT 84606
(801) 344-4400
✔ PECOS✔ Accepts Medicare14 mi
Denise Goettsche, DO
General Practice
NPI 1740225218
1300 E CENTER ST
Provo, UT 84606
(801) 344-4400
✔ PECOS✔ Accepts Medicare14 mi
See all 84 clinicians

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 for Provider-Performed Microscopy Procedures (PPMP) 46D0683172

Utah State Developmental Center · Am Fork, UT
Active · expires Sep 3, 2027
CLIA Number46D0683172
Laboratory TypeIntermediate Care Facility For Mentally Retarded
Certificate Effective DateSeptember 4, 2025
Certificate Expiration DateSeptember 3, 2027
Laboratory DirectorSteven D. Monson
Laboratory Phone(801) 763-4000
Laboratory LocationUtah State Developmental Center895 N 900 E, Am Fork, UT 84003
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform 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 Utah State Developmental Center's NPI number?

The NPI number for Utah State Developmental Center is 1689674301. It was assigned to this organization in the NPPES registry on July 22, 2005.

Where is Utah State Developmental Center located?

Utah State Developmental Center is located at 895 N. 900 E., American Fork, UT 84003. The listed phone number is (801) 763-4000.

What is Utah State Developmental Center's specialty?

The primary specialty registered for this NPI is Intermediate Care Facility, Mental Illness with taxonomy code 310500000X.

Is Utah State Developmental Center enrolled in Medicare?

Yes. Utah State Developmental Center is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Utah State Developmental Center?

According to the CMS Revalidation Reassignment List (October 2026 release), 84 clinicians in 9 Medicare specialties reassign their Medicare billing to Utah State Developmental Center. 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. The largest specialties are Clinical Social Worker (27), Psychiatry (14) and Clinical Psychologist (13). Of these, 5 practice at this address and 10 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Utah State Developmental Center hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 46D0683172) is associated with this NPI, valid through September 3, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Utah State Developmental Center was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.