Shriners Hospitals for Children

Primary specialty

Rehabilitation Clinic/CenterTaxonomy code 261QR0400X

Legal business name

SHRINERS HOSPITALS FOR CHILDREN

Practice address

1275 E Fairfax Rd
Salt Lake City, UT 84103-4324

Phone

(801) 536-3500

NPI assigned

Jun 25, 2021

Organization subpart

No

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

Authorized official

Name

Jerry G. Gantt

Title

President

Phone

(813) 281-0300

Specialties & licenses 2

Addresses

Other names 1

• Shriners Hospitals for Children Rehabilitation Clinic Other name

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Shriners Hospitals for Children

  • Pediatric Orthopaedic Surgery Physician
  • Salt Lake City, UT
  • NPI 1396187282

  O20140703000851

  Same enrollment
• Shriners Hospitals for Children

  • Anesthesiology Physician
  • Salt Lake City, UT
  • NPI 1528556776

  O20140703000851

  Same enrollment
• Shriners Hospitals for Children

  • Orthopaedic Surgery Physician
  • Philadelphia, PA
  • NPI 1275271462

  O20140703000851

  Same enrollment

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Judith L Gooch, MD

  • Physical Medicine & Rehabilitation Physician
  • SLC, UT
  • NPI 1437268588
  NPD
• Scott Michael Jerome, PT

  • Physical Therapist
  • Salt Lake City, UT
  • NPI 1861571648
  NPD
• Joshua William Bendz Klatt, M.D.

  • Pediatric Orthopaedic Surgery Physician
  • Bozeman, MT
  • NPI 1063683209
  NPD

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

{
    "created_epoch": "1624579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624579200000",
    "number": "1033789755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8500 LOCKBOX 7642",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191781435",
            "telephone_number": "813-281-0300",
            "fax_number": "813-281-0943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1275 E FAIRFAX RD",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841034324",
            "telephone_number": "801-536-3500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHRINERS HOSPITALS FOR CHILDREN",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-25",
        "last_updated": "2021-06-25",
        "certification_date": "2021-06-11",
        "status": "A",
        "authorized_official_last_name": "GANTT",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "813-281-0300"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shriners Hospitals for Children Rehabilitation Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kimberly Shreeve
• Myranda A Shrestha
• Melissa Shrewsbury, CMHC
• Michael Byard Shrewsbury
• Dennis C Shrieve, M.D.
• Shriners Hospitals for Children
• Shriners Hospitals for Children
• Shriners Hospitals for Children
• Shrinkster, LLC
• Shroy Healthcare Pharmaceuticals Inc

• Rehabilitation Clinic/Center in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Rehabilitation Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.