Individual provider Active NPI

Jeffrey R Lish, M.D.

  • Family Medicine Physician
  • Brigham City, UT
National Provider Identifier
1003848797
Registry record updated Jun 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
178575-1205 Issued in UT
Practice address
1041 S Medical Dr Ste 200
Brigham City, UT 84302-3293
Phone
(435) 723-5248
Fax
(435) 723-5240
NPI assigned
Jul 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 178575-1205 UT Primary

Addresses

Primary practice location

1041 S Medical Dr Ste 200
Brigham City, UT 84302-3293

Mailing address

1041 S Medical Dr Ste 200
Brigham City, UT 84302-3293
Phone (435) 723-5248

Other identifiers 1

IdentifierTypeStateIssuer
870282100012MedicaidUT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040325001053 UT Practitioner - Family Practice 3375435357 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medical Arts Center Clinic of Brigham City IncGroup PAC ID 9931000460, 10 clinicians

Practice addresses (Care Compare)

1041 S Medical Dr
Suite 200
Brigham City, UT 84302-3293
Phone (435) 723-5248

Hospital & facility affiliations

  • Ascend Home Health Home health agency, Logan, UT, CCN 467228
  • Brigham City Community Hospital Hospital, Brigham City, UT, CCN 460017
  • Bear River Valley Hospital Hospital, Tremonton, UT, CCN 460039
  • Intermountain Health McKay-Dee Hospital Hospital, Ogden, UT, CCN 460004
  • Intermountain Health Logan Regional Hospital Hospital, Logan, UT, CCN 460015

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Advantage Medical Center LLC Family Medicine CurrentSince Apr 12, 2017 Accepting new patients

Locations

770 S 200 E
#102
Brigham City, UT 84302
Phone (435) 723-0517

Networks

  • UT PPO
  • UT PPO D-SNP

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/24655/brand/1/csg/1/fhir/r4
  • Direct secure messaging: jeffrey.lish.1@24655.direct.athenahealth.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781568000000",
    "number": "1003848797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1041 S MEDICAL DR STE 200",
            "city": "BRIGHAM CITY",
            "state": "UT",
            "postal_code": "843023293",
            "telephone_number": "435-723-5248",
            "fax_number": "435-723-5240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1041 S MEDICAL DR STE 200",
            "city": "BRIGHAM CITY",
            "state": "UT",
            "postal_code": "843023293",
            "telephone_number": "435-723-5248",
            "fax_number": "435-723-5240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LISH",
        "first_name": "JEFFREY",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-06",
        "last_updated": "2026-06-16",
        "certification_date": "2026-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "178575-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "870282100012",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brigham City, UT

Sources for this page

Verify at the official NPI Registry.