NPIMap

Project Reality

A Medicare group practice based in Salt Lake City, UT: 2 NPIs enrolled under one PECOS associate control ID (PAC ID 4082669825), with 20 clinicians.

Medicare enrollment

Medicare enrollment files
PAC ID
4082669825The PECOS associate control ID: one enrolled organization, which may hold several NPIs
Provider type
Part B Supplier - Clinic/Group Practice, Part B Supplier - Opioid Treatment Program (Otp)
Enrolled in
UT
Enrollments
2
Group size
5 cliniciansAs Care Compare reports it
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Practice locations
3In 2 places

Enrollment records 2

Enrollment IDStateProvider typeNPI
O20231115002254 UT Part B Supplier - Opioid Treatment Program (Otp) 1134211626
O20050315000564 UT Part B Supplier - Clinic/Group Practice 1134211626

NPIs in this group 2

NPPES NPI Registry

These NPI records belong to the same enrolled organization. Each has its own page.

Practice locations

Locations on the Medicare enrollment

Clinicians 20

Clinicians who reassign their Medicare benefits to this group (20) or whom Care Compare lists as members (5).

Sources for this page