Individual provider Active NPI

Seth M. Illu, MD

  • Emergency Medical Services (Emergency Medicine) Physician
  • Salt Lake City, UT
National Provider Identifier
1043960396
Registry record updated Dec 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X
License
14206975-1205 Issued in UT
Practice address
30 N Mario Capecdai Dr RM 2S200
Salt Lake City, UT 84112
Phone
(801) 581-2121
NPI assigned
Mar 28, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X 14206975-1205 UT Primary

Addresses

Primary practice location

30 N Mario Capecdai Dr RM 2S200
Salt Lake City, UT 84112

Mailing address

30 N Mario Capecdai Dr RM 2S200
Salt Lake City, UT 84112
Phone (801) 581-2121

Other practice location 1

743 Spring St NE Ste 710
Gainesville, GA 30501-3715
Phone (770) 219-8730

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sillu206229@direct.med.utah.edu Direct University of Utah

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS, UT2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20250624002887 MS Practitioner - Emergency Medicine 4284014655 Reassigns benefits to 1 organization
I20250729000288 UT Practitioner - Emergency Medicine 4284014655 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Utah Adult ServicesGroup PAC ID 0941525273, 1,758 clinicians

Practice addresses (Care Compare)

50 N Medical Dr
Salt Lake City, UT 84132-0100
Phone (801) 585-6387

Hospital & facility affiliations

  • Singing River Gulfport Hospital, Gulfport, MS, CCN 250123
  • University of Utah Hospital and Clinics Hospital, Salt Lake City, UT, CCN 460009

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
14206975-1205UTMDEmergency Medical Services (Emergency Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Illuminate Medical LLC Current Accepting new patients
Mississippi Emergency Department Services PC Emergency Medicine CurrentSince Jun 17, 2025 Accepting new patients
University of Utah Adult Services Current Accepting new patients
University of Utah Adult Services CurrentSince Jun 15, 2025 Accepting new patients
University of Utah Adult Services CurrentSince Jun 15, 2025 Accepting new patients

Locations

3109 Bienville Blvd
Ocean Springs, MS 39564
Phone (228) 818-1100

127 S 500 E
Salt Lake Cty, UT 84102

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

Interoperability endpoints

  • Direct secure messaging: sillu206229@direct.med.utah.edu

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

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": "1648425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766966400000",
    "number": "1043960396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 N MARIO CAPECDAI DR RM 2S200",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "84112",
            "telephone_number": "801-581-2121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 N MARIO CAPECDAI DR RM 2S200",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "84112",
            "telephone_number": "801-581-2121"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "743 Spring St NE Ste 710",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "GA",
            "postal_code": "305013715",
            "country_code": "US",
            "telephone_number": "770-219-8730",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ILLU",
        "first_name": "SETH",
        "middle_name": "M.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-28",
        "last_updated": "2025-12-29",
        "certification_date": "2025-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "UT",
            "license": "14206975-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sillu206229@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.