Mario Damon La Giglia, DO
Individual provider Active NPI Surgery Physician · Blanding, UT
NPI 1013145697 · NPPES record last updated Apr 3, 2019
Key facts
- NPI
- 1013145697
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgery Physician 208600000X
- License
- 9743925-1204 (UT)
- Practice address
- 802 S 200 W
Blanding, UT 84511-3910 - Phone
- (435) 678-3993
- Fax
- (435) 678-3992
- NPI assigned
- Jun 23, 2009
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- General Surgery
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Blue Mountain Hospital
Practice addresses (Care Compare)
802 S 200
Blanding, UT 84511-3910
Phone (435) 678-3993
Hospital & facility affiliations
- Blue Mountain Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Colonoscopy | 1-10 |
| Upper gastrointestinal (GI) endoscopy for acid reflux | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180412001498 | UT | Practitioner - General Surgery | 2860782927 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2015-02260 | NC | MD | Surgery Physician |
| 9743925-1204 | UT | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| San Juan County Hospital | Family Medicine | Current |
Accepting new patients |
| San Juan County Hospital | Current | Accepting new patients | |
| Blue Mountain Hospital | Current |
Accepting new patients | |
| San Juan County Hospital | Current |
Accepting new patients | |
| San Juan County Hospital | Family Medicine | Current | Accepting new patients |
Locations
802 S 200 W
Blanding, UT 84511
Phone (435) 678-3869
802 S 200 W
Ste A
Blanding, UT 84511
Phone (435) 678-3993
Interoperability endpoints
- mario.lagiglia.2@16299.direct.athenahealth.com
- https://fhir-myrecord.cerner.com/r4/d2bc3d5a-3c39-4553-86b1-b3aa0a5429a7/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Military Health Care Provider | 171000000X | |||
| Surgery Physician | 208600000X | 2015-02260 | NC | |
| Surgery Physician | 208600000X | 9743925-1204 | UT | Yes |
Addresses
Primary practice location
802 S 200 W
Blanding, UT 84511-3910
Mailing address
802 S 200 W
Blanding, UT 84511-3910
Phone (435) 678-3993
Other practice location 1
2260 Rodeo Drive
Linden, NC 28356
Phone (915) 540-2736
Other providers in Blanding, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 3, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.