Individual provider Active NPI

Richard Brennan Blackham, M.D.

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Murray, UT
National Provider Identifier
1043470990
Registry record updated Jun 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X
License
8627317-1205 Issued in UT
Practice address
5171 S Cottonwood St Ste 180
Murray, UT 84107-5704
Phone
(801) 507-9800
Fax
(801) 507-9801
NPI assigned
Jun 13, 2008
Last updated
Jun 8, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Physical Medicine & Rehabilitation) Physician 2081P2900X 8627317-1205 UT Primary
Pain Medicine (Physical Medicine & Rehabilitation) Physician 2081P2900X 46108 AZ

Addresses

Primary practice location

5171 S Cottonwood St Ste 180
Murray, UT 84107-5704

Mailing address

PO Box 27128
Salt Lake City, UT 84127-0128
Phone (801) 507-9800

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRReguest_Service Other Bluemark LLC / Office Ally

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
I20130731000475 UT Practitioner - Physical Medicine and Rehabilitation 9739338039 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
University of Utah School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Practice addresses (Care Compare)

3249 N 1200
Lehi, UT 84043-9772
Phone (801) 753-4300

5171 S Cottonwood St
Murray, UT 84107-5704
Phone (801) 507-9310

700 S Hwy 99
Suite 3
Fillmore, UT 84631-5137
Phone (801) 357-4600

9660 S 1300
Sandy, UT 84094-3762
Phone (801) 501-2600

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
8627317-1205UTMDPain Medicine (Physical Medicine & Rehabilitation) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services, Inc. CurrentSince Jul 29, 2013 Accepting new patients
Ihc Health Services Inc Physical Medicine & Rehabilitation CurrentSince Jul 29, 2013 Accepting new patients
Ihc Health Services Inc Current Accepting new patients
Ihc Health Services Inc Past Accepting new patients

Locations

700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555

5171 S Cottonwood St
Ste 210
Salt Lake City, UT 84107

5171 S Cottonwood St
Ste 810
Salt Lake City, UT 84107
Phone (801) 507-9800

5171 S Cottonwood St
Ste 910
Salt Lake City, UT 84107
Phone (801) 507-9950

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.

Hospital & facility affiliations 3

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": "1213315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780876800000",
    "number": "1043470990",
    "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",
            "telephone_number": "801-507-9800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5171 S COTTONWOOD ST STE 180",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841075704",
            "telephone_number": "801-507-9800",
            "fax_number": "801-507-9801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKHAM",
        "first_name": "RICHARD",
        "middle_name": "BRENNAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-13",
        "last_updated": "2026-06-08",
        "certification_date": "2026-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "UT",
            "license": "8627317-1205",
            "primary": true
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "AZ",
            "license": "46108",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRReguest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.3",
            "affiliationName": "Bluemark LLC / Office Ally",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "1300 SE Cardinal Ct Ste 190",
            "city": "Vancouver",
            "state": "WA",
            "country_code": "US",
            "postal_code": "986839683",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Murray, UT

Sources for this page

Verify at the official NPI Registry.