NPIMap

Organization Active NPI

Mountainstar Medical Group-St. Marks Hospital, LLC

  • Family Medicine Physician
  • Salt Lake City, UT
National Provider Identifier
1073795258
Registry record updated Jan 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MOUNTAINSTAR MEDICAL GROUP-ST. MARKS HOSPITAL, LLC
Practice address
348 E 4500 S Ste 300
Salt Lake City, UT 84107-8535
Phone
(801) 266-2777
NPI assigned
Nov 29, 2007
Last updated
Jan 2, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2023

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

Authorized official

Name
Louis Joseph
Title
VP
Phone
(615) 373-7630

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

348 E 4500 S Ste 300
Salt Lake City, UT 84107-8535

Mailing address

2000 Health Park Dr
Brentwood, TN 37027-4525
Phone (615) 373-7600

Other identifiers 1

IdentifierTypeStateIssuer
1073795258MedicaidUT

Other names 1

  • St. Mark's Millcreek Primary Care Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080201000093 UT Part B Supplier - Clinic/Group Practice 1557443322 Receives reassigned benefits from 15 practitioners
Practice locations: West Jordan, UT; Taylorsville, UT; South Jordan, UT; Sandy, UT; Salt Lake City, UT; Cedar Hills, UT; Draper, UT; Murray, UT

National Provider Directory

National Provider Directory

Locations

11637 S 700 E
Draper, UT 84020
Phone (801) 523-9393

96 E Kimballs Ln
Ste 207
Draper, UT 84020
Phone (801) 568-5972

348 E 4500 S
Ste 300
Salt Lake City, UT 84107
Phone (801) 266-2777

2130 E 9400 S
Sandy, UT 84093
Phone (801) 453-9600

10623 S Redwood Rd
South Jordan, UT 84095

654 E 3300 S
South Salt Lake, UT 84106
Phone (385) 500-2090

5360 S 2700 W
Taylorsville, UT 84129
Phone (801) 262-5711

8846 S Redwood Rd
West Jordan, UT 84088
Phone (801) 569-1999

8846 S Redwood Rd
Ste E12
West Jordan, UT 84088
Phone (801) 266-2777

Practitioners & affiliated clinicians

Practitioners 48

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 48

NPI Registry JSON

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

{
    "created_epoch": "1196294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672617600000",
    "number": "1073795258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 HEALTH PARK DR",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370274525",
            "telephone_number": "615-373-7600",
            "fax_number": "866-346-1426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "348 E 4500 S STE 300",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841078535",
            "telephone_number": "801-266-2777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAINSTAR MEDICAL GROUP-ST. MARKS HOSPITAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-29",
        "last_updated": "2023-01-02",
        "certification_date": "2023-01-02",
        "status": "A",
        "authorized_official_last_name": "JOSEPH",
        "authorized_official_first_name": "LOUIS",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "615-373-7630"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1073795258",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Mark's Millcreek Primary Care",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "St. Mark's Millcreek Primary Care",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.