Active NPI
Courtney Farrell, NP
- Neonatal Nurse Practitioner
- Salt Lake City, UT
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neonatal Nurse Practitioner
- License
- 12864933-4405
- Practice address
- 100 N Mario Capecchi Dr
Salt Lake City, UT 84113-1103 - Phone
- (801) 662-4261
- Fax
- (801) 662-4285
- NPI assigned
- Jul 14, 2016
- Last updated
- Feb 2, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neonatal Nurse Practitioner | 363LN0000X | 12864933-4405 | UT | Primary |
| Pediatric Nurse Practitioner | 363LP0200X | 382637 | NY |
Addresses
Primary practice location
100 N Mario Capecchi Dr
Salt Lake City, UT 84113-1103
Mailing address
PO Box 27128
Salt Lake City, UT 84127-0128
Other practice location 1
1555 Long Pond Rd
Family Birth Place
Rochester, NY 14626-4122
Phone (585) 368-4006
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04539382 | Medicaid | NY |
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: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 382637 | NY | MD | Pediatric Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ihc Health Services, Inc. | Current | Accepting new patients | |
| Ihc Health Services Inc | Current | Accepting new patients | |
| Ihc Health Services Inc | Current | Accepting new patients | |
| Ihc Health Services Inc | Current | Accepting new patients |
Locations
700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555
9660 S 1300 E
Sandy, UT 84094
Phone (801) 314-2417
100 N Mario Capecchi Dr
Slc, UT 84113
Phone (801) 587-7109
Organizations & group practices 4
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.
-
dba IMED Physicians Billing
- Multi-Specialty Clinic/Center
- Murray, UT
- NPI 1629260880
-
- Multi-Specialty Clinic/Center
- Sandy, UT
- NPI 1942325154
-
dba Mountain Family Health
- Family Medicine Physician
- Park City, UT
- NPI 1588074256
-
dba St George Adolescent Partial Hospitalization
- Psychiatry Physician
- St George, UT
- NPI 1023843844
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1468454400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675296000000",
"number": "1023461068",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 27128",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841270128"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 N MARIO CAPECCHI DR",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841131103",
"telephone_number": "801-662-4261",
"fax_number": "801-662-4285"
}
],
"practiceLocations": [
{
"address_1": "1555 Long Pond Rd",
"address_2": "Family Birth Place",
"address_purpose": "LOCATION",
"city": "Rochester",
"state": "NY",
"postal_code": "146264122",
"country_code": "US",
"telephone_number": "585-368-4006",
"fax_number": "585-368-4009",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "FARRELL",
"first_name": "COURTNEY",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-07-14",
"last_updated": "2023-02-02",
"certification_date": "2023-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "363LN0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Neonatal",
"state": "UT",
"license": "12864933-4405",
"primary": true
},
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "NY",
"license": "382637",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "04539382",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.