Active NPI
Greg Speziale
- Peer Specialist
- Park City, UT
National Provider Identifier
1043966591
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- 1478
- Practice address
- 36 Racquet Club Dr
Park City, UT 84060 - Phone
- (801) 425-8767
- NPI assigned
- Feb 23, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | 1478 | UT | Primary |
Addresses
Primary practice location
36 Racquet Club Dr
Park City, UT 84060
Mailing address
2100 Park Ave Unit 682941
Park City, UT 84068-4619
Phone (801) 425-8767
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1478 | Other | UT | STATE OF UTAH CERTIFIED PEER SUPPORT SPECIALIST |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1478 | UT | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1645574400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1645574400000",
"number": "1043966591",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2100 PARK AVE UNIT 682941",
"city": "PARK CITY",
"state": "UT",
"postal_code": "840684619",
"telephone_number": "801-425-8767"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "36 RACQUET CLUB DR",
"city": "PARK CITY",
"state": "UT",
"postal_code": "84060",
"telephone_number": "801-425-8767"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPEZIALE",
"first_name": "GREG",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-02-23",
"last_updated": "2022-02-23",
"certification_date": "2022-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "UT",
"license": "1478",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF UTAH CERTIFIED PEER SUPPORT SPECIALIST",
"identifier": "1478",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Park City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.