Mark J Cacciamani, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

49426771205 Issued in UT

Practice address

466 E 500 S Ste 200
Salt Lake City, UT 84111-3350

Phone

(801) 485-5055

Fax

(801) 467-3296

NPI assigned

Oct 11, 2006

Last updated

Aug 19, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in UT, ID, NY, CO4 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 4

Specialty

Family Practice

Education

Georgetown University School of Medicine, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ma Bo IncGroup PAC ID 1254399652, shared by 2 NPIs, 5 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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

• Salisbury Assisted Living, LLC

  • Assisted Living Facility
  • Salt Lake City, UT
  • NPI 1629616867
  NPD Authorized official
• Ma Bo Inc

  • Family Medicine Physician
  • Salt Lake City, UT
  • NPI 1588185581

  CO, ID

  Medicare reassignment
• Ma Bo Inc

  dba House Call Doctors

  • Family Medicine Physician
  • Salt Lake City, UT
  • NPI 1740461219
  Medicare reassignment
• Ma Bo Inc

  • Family Medicine Physician
  • Salt Lake City, UT
  • NPI 1275182487
  NPD (past)

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724025600000",
    "number": "1063500163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "522 E 100 S",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841021905",
            "telephone_number": "801-485-5055",
            "fax_number": "801-467-3296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "466 E 500 S STE 200",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841113350",
            "telephone_number": "801-485-5055",
            "fax_number": "801-467-3296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CACCIAMANI",
        "first_name": "MARK",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-11",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "49426771205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "000057838",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D4498",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• C3 Physical Therapy and Health & Wellness Services
• Hayley Victoria Cabacar
• Autumn Grace Cabaniss, LPN
• Anne Laurice Semilla Cabrera, MS, PHD
• Lorena Cabuslay
• Christian Caceres, MD
• Cadenza Family Dentistry PC
• Ashley Cafferty, PHYSICIAN ASSISSTANT
• Sarah Caffry, MD
• Alyssa Caggiano, PT, DPT

• Family Medicine Physician in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Family Medicine Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.