NPIMap

Individual provider Active NPI

Cole Joseph Panushka, M.D.

  • Diagnostic Radiology Physician
  • Farmington, UT
National Provider Identifier
1053392050
Registry record updated Feb 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
1825061205 Issued in UT
Practice address
1433 N 1075 W Ste 104
Farmington, UT 84025-2746
Phone
(801) 298-1300
Fax
(801) 296-6199
NPI assigned
Nov 8, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 1825061205 UT Primary

Addresses

Primary practice location

1433 N 1075 W Ste 104
Farmington, UT 84025-2746

Mailing address

PO Box 25488
Salt Lake City, UT 84125-0488
Phone (800) 475-3698

Other practice location 1

380 N 200 W
Suite 209
Bountiful, UT 84010-7079
Phone (801) 298-1300

Other identifiers 6

IdentifierTypeStateIssuer
P00199626OtherUTRR MEDICARE
120889600MedicaidWY
P00651556OtherUTRR MEDICARE
10058MedicaidUT
807112800MedicaidID
931718MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041220001003 UT Practitioner - Diagnostic Radiology 4789642901 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Utah School of Medicine, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tooele Valley Imaging LLCGroup PAC ID 2466624630, 24 clinicians
Utah Imaging Associates IncGroup PAC ID 1355394537, 45 clinicians

Practice addresses (Care Compare)

2356 N 400
Suite 103
Tooele, UT 84074-3409
Phone (435) 882-1674

630 Medical Dr
Bountiful, UT 84010-4908
Phone (801) 299-2220

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.06 of 100Reported as group
Quality
100
Improvement activities
40
Cost
76.86

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1825061205UTMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tanner Memorial Clinic CurrentSince Nov 13, 2024 Accepting new patients
Revere Health PC CurrentSince Jun 15, 2021 Accepting new patients
Wasatch Imaging LLC CurrentSince Sep 15, 2024 Accepting new patients
Green River Radiology, P.C. Diagnostic Radiology CurrentSince Dec 15, 2021 Accepting new patients
Revere Health PC CurrentSince Jun 15, 2021 Accepting new patients
Tanner Memorial Clinic CurrentSince Nov 13, 2024 Accepting new patients
Tooele Valley Imaging, LLC CurrentSince Oct 1, 2020 Accepting new patients
Utah Imaging Centers LLC Past Accepting new patients
Schryver Medical Sales and Marketing LLC Past Accepting new patients
West Valley Imaging LLC Diagnostic Radiology Past Accepting new patients
Ogden Imaging LLC Diagnostic Radiology Past Accepting new patients
New Schryver LLC Past Accepting new patients
Scott E Southworth MD PC Past Accepting new patients
Wasatch Vascular Center LLC PastSince Nov 1, 2019 Accepting new patients

Locations

1175 E 50 S
Ste 141
American Fork, UT 84003
Phone (801) 492-5996

1433 N 1075 W
Ste 104
Farmington, UT 84025
Phone (801) 299-2200

425 S 100 W
Layton, UT 84041
Phone (801) 682-8708

1600 W Antelope Dr
Layton, UT 84041
Phone (801) 807-1000

1055 N 500 W
Ste 112
Provo, UT 84604
Phone (801) 812-4624

1055 N 500 W
Provo, UT 84604
Phone (801) 429-8000

12842 S 3600 W
Ste 100
Riverton, UT 84065
Phone (385) 253-4586

9844 S 1300 E
Ste 175
Sandy, UT 84094
Phone (801) 576-1290

6243 S Redwood Rd
Ste 130
Taylorsville, UT 84123
Phone (801) 288-9671

2055 N Main St
Tooele, UT 84074
Phone (435) 843-3600

2356 N 400 E
Ste 103
Tooele, UT 84074
Phone (435) 882-1674

Organizations & group practices 15

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.

View all 15

Hospital & facility affiliations 6

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": "1131408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550534400000",
    "number": "1053392050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 25488",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841250488",
            "telephone_number": "800-475-3698",
            "fax_number": "801-296-6199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1433 N 1075 W STE 104",
            "city": "FARMINGTON",
            "state": "UT",
            "postal_code": "840252746",
            "telephone_number": "801-298-1300",
            "fax_number": "801-296-6199"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "380 N 200 W",
            "address_2": "Suite 209",
            "address_purpose": "LOCATION",
            "city": "Bountiful",
            "state": "UT",
            "postal_code": "840107079",
            "country_code": "US",
            "telephone_number": "801-298-1300",
            "fax_number": "801-296-6199",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PANUSHKA",
        "first_name": "COLE",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-08",
        "last_updated": "2019-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "UT",
            "license": "1825061205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00199626",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "120889600",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00651556",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10058",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807112800",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "931718",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, UT

Sources for this page

Verify at the official NPI Registry.