NPIMap

Individual provider Active NPI

Kevin R Duke, D.O.

  • Family Medicine Physician
  • Providence, UT
National Provider Identifier
1003882713
Registry record updated May 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
290545-1204 Issued in UT
Practice address
382 W 280 N
Providence, UT 84332-0609
Phone
(435) 752-0330
Fax
(435) 755-0922
NPI assigned
Feb 23, 2006
Last updated
May 11, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 11, 2021

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 290545-1204 UT Primary

Addresses

Primary practice location

382 W 280 N
Providence, UT 84332-0609

Mailing address

1219 N 400 E
North Logan, UT 84341-2321

Other identifiers 1

IdentifierTypeStateIssuer
1003001959OtherUTCORP NPI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111219000058 UT Practitioner - Family PracticePractitioner - General Practice 8820028673 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Living Tree Medical GroupGroup PAC ID 5294128963, 5 clinicians

Practice addresses (Care Compare)

1219 N 400
Logan, UT 84341-2321
Phone (435) 565-6043

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Living Tree Medical Group Family Medicine CurrentSince Sep 22, 2021 Accepting new patients
Living Tree Urgent Care PastSince Sep 1, 2021 Accepting new patients

Locations

1219 N 400 E
North Logan, UT 84341
Phone (435) 565-6043

1635 N 200 E
North Logan, UT 84341
Phone (435) 565-6043

169 N Gateway Dr
Ste 170
Providence, UT 84332
Phone (435) 565-6043

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/HHEFCD/Endpoint/HHEFCD
  • FHIR API: https://fhir4.healow.com/fhir/r4/IEBGCD/Endpoint/IEBGCD

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Sunshine HospiceLogan, UT, CCN 461597 Hospice Contracted Managing Employee
Corporate Director		 May 1, 2024
Apr 1, 2018

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

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

Hospital & facility affiliations 6

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": "1140652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620691200000",
    "number": "1003882713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1219 N 400 E",
            "city": "NORTH LOGAN",
            "state": "UT",
            "postal_code": "843412321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "382 W 280 N",
            "city": "PROVIDENCE",
            "state": "UT",
            "postal_code": "843320609",
            "telephone_number": "435-752-0330",
            "fax_number": "435-755-0922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUKE",
        "first_name": "KEVIN",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-23",
        "last_updated": "2021-05-11",
        "certification_date": "2021-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "290545-1204",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CORP NPI",
            "identifier": "1003001959",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, UT

Sources for this page

Verify at the official NPI Registry.