NPIMap

Organization Active NPI

Premier Family Medical - Eagle Mountain

  • Family Medicine Physician
  • Eagle Mountain, UT
National Provider Identifier
1043762479
Registry record updated Mar 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PREMIER FAMILY MEDICAL - EAGLE MOUNTAIN
Practice address
3943 E Pony Express Pkwy Ste 120
Eagle Mountain, UT 84005-5543
Phone
(801) 756-3511
Fax
(801) 756-1705
NPI assigned
Nov 2, 2016
Organization subpart
Yes
Parent organization
PREMIER FAMILY MEDICALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 22, 2024

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

Authorized official

Name
Heather Guymon
Title
Credentialing Specialist
Phone
(801) 769-2571

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

3943 E Pony Express Pkwy Ste 120
Eagle Mountain, UT 84005-5543

Mailing address

3943 E Pony Express Pkwy Ste 120
Eagle Mountain, UT 84005-5543
Phone (801) 789-5566

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130710000079 UT Part B Supplier - Clinic/Group Practice 7416197785 Receives reassigned benefits from 106 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lindon, UT; Vineyard, UT; Saratoga Springs, UT; Pleasant Grove, UT; Lehi, UT; Eagle Mountain, UT; American Fork, UT

National Provider Directory

National Provider Directory
Part of
Premier Family Medical - Traverse Mountain

Other NPIs on the same Medicare enrollment 11

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

Practitioners 7

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
46D2125977Premier Family Medical-Eagle Mountain3943 East Pony Express Parkway #120, Eagle Mountain, UT 84005Provider-performed microscopyFeb 15, 2027

NPI Registry JSON

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

{
    "created_epoch": "1478044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711065600000",
    "number": "1043762479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3943 E PONY EXPRESS PKWY STE 120",
            "city": "EAGLE MOUNTAIN",
            "state": "UT",
            "postal_code": "840055543",
            "telephone_number": "801-789-5566",
            "fax_number": "801-642-2941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3943 E PONY EXPRESS PKWY STE 120",
            "city": "EAGLE MOUNTAIN",
            "state": "UT",
            "postal_code": "840055543",
            "telephone_number": "801-756-3511",
            "fax_number": "801-756-1705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER FAMILY MEDICAL - EAGLE MOUNTAIN",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PREMIER FAMILY MEDICAL",
        "enumeration_date": "2016-11-02",
        "last_updated": "2024-03-22",
        "certification_date": "2024-03-22",
        "status": "A",
        "authorized_official_last_name": "GUYMON",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "801-769-2571"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagle Mountain, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.