NPIMap

Individual provider Active NPI

Ilyssa Golding, MD

  • Diagnostic Radiology Physician
  • Salt Lake City, UT
National Provider Identifier
1063448371
Registry record updated Jan 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
8295697-1205 Issued in UT
Practice address
1200 E 3900 S
Salt Lake City, UT 84124-1300
Phone
(801) 268-7111
Fax
(801) 296-6199
NPI assigned
Jun 26, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X G78242 CA
Diagnostic Radiology Physician 2085R0202X 8295697-1205 UT Primary

Addresses

Primary practice location

1200 E 3900 S
Salt Lake City, UT 84124-1300

Mailing address

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

Other identifiers 12

IdentifierTypeStateIssuer
1063448371OtherUTUNIVERSITY OF UTAH HEALTH PLANS
939166OtherUTWINDSOR HEALTH PLAN MEDICAREEXTRA/STERLING HEALTH PLAN
1063448371OtherUTEMI HEALTH
1063448371OtherUTTRICARE
567412OtherUTDESERET MUTUAL BENEFIT ADMINISTRATORS
00G782420OtherCABLUE SHIELD
00G782420MedicaidCA
10000007105001OtherUTREGENCE BCBSU
1063448371MedicaidUT
1063448371OtherUTMOLINA HEALTHCARE
138686OtherUTPEHP
P01075932OtherUTRAILROAD MEDICARE

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)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G78242CAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Utah Imaging Associates Inc Diagnostic Radiology PastSince Jan 1, 2005 Accepting new patients
UCLA Radiology Medical Group Diagnostic Radiology Past Accepting new patients
Ogden Imaging LLC Diagnostic Radiology Past Accepting new patients
Cedars-Sinai Imaging Medical Group a Professional Corporation Diagnostic Radiology PastSince Dec 12, 2021 Accepting new patients
West Valley Imaging LLC Diagnostic Radiology Past Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358380800000",
    "number": "1063448371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "380 N 200 W",
            "address_2": "SUITE 209",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840107079",
            "telephone_number": "801-298-1300",
            "fax_number": "801-296-6199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 E 3900 S",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841241300",
            "telephone_number": "801-268-7111",
            "fax_number": "801-296-6199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLDING",
        "first_name": "ILYSSA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-26",
        "last_updated": "2013-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "G78242",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "UT",
            "license": "8295697-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERSITY OF UTAH HEALTH PLANS",
            "identifier": "1063448371",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WINDSOR HEALTH PLAN MEDICAREEXTRA/STERLING HEALTH PLAN",
            "identifier": "939166",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMI HEALTH",
            "identifier": "1063448371",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "1063448371",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DESERET MUTUAL BENEFIT ADMINISTRATORS",
            "identifier": "567412",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "00G782420",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G782420",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BCBSU",
            "identifier": "10000007105001",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1063448371",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MOLINA HEALTHCARE",
            "identifier": "1063448371",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEHP",
            "identifier": "138686",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01075932",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.