Ivy Lane Pediatrics, LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

IVY LANE PEDIATRICS, LLC

Practice address

5974 Fashion Point Dr Ste 230
South Ogden, UT 84403-4805

Phone

(801) 774-9698

Fax

(801) 728-0641

NPI assigned

Jul 21, 2006

Organization subpart

No

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

Authorized official

Name

Wyndam Reeve, MD

Title

Administrator

Phone

(801) 774-9698

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Home health agency certification: CCN 467230

Legal name

IVY LANE PEDIATRICS LLC

Doing business as

AMAZING CARE HOME HEALTH SERVICES LLC

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Oct 20, 2006

Last certification

Dec 3, 2020

Ownership / control type

Proprietary

Organization structure

LLCProprietary

Incorporated

Jul 18, 2006 in UT

Enrollment address

5974 Fashion Point Dr
Ste 230
South Ogden, UT 84403-4805

Listed as

Amazing Care Home Health Services LLCCCN 467230

Ownership

Proprietary

Certified

Oct 20, 2006

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Home health aide, Physical therapy, Speech pathology, Occupational therapy

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Amazing Care Home Health Services, LLC

  • Home Health Agency
  • Aurora, CO
  • NPI 1407965122

  Member Of

  NPD member

Locations

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Amazing Care Home Health Services, LLC

  • Home Health Agency
  • Aurora, CO
  • NPI 1407965122

  5% Or Greater Direct Ownership Interest

  CMS ownership

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ashley Jean Goebel, CSW

  • Social Worker
  • Logan, UT
  • NPI 1912520495
  NPD (past)
• Karen Jean Lacy, LCSW

  • Clinical Social Worker
  • Providence, UT
  • NPI 1285735415
  NPD (past)

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Trenaisa Nay, APRN-BC,NP

  • Gerontology Nurse Practitioner
  • Provo, UT
  • NPI 1447373451

  Home health agency

  Care Compare affiliation

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642723200000",
    "number": "1083635692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5974 FASHION POINT DR STE 230",
            "city": "SOUTH OGDEN",
            "state": "UT",
            "postal_code": "844034805",
            "telephone_number": "801-774-9698",
            "fax_number": "801-728-0641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5974 FASHION POINT DR STE 230",
            "city": "SOUTH OGDEN",
            "state": "UT",
            "postal_code": "844034805",
            "telephone_number": "801-774-9698",
            "fax_number": "801-728-0641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVY LANE PEDIATRICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-21",
        "last_updated": "2022-01-21",
        "certification_date": "2022-01-21",
        "status": "A",
        "authorized_official_last_name": "REEVE",
        "authorized_official_first_name": "WYNDAM",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "801-774-9698",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intermountain Allergy & Immunology Clinic
• Elizabeth Henry Ireland, RN
• Charles Thomas Ivester, MD
• Boyd Lee Jacobson, D.D.S., M.S.
• Stephen James, RBT
• Wojciech C Janowski, MD
• Allison R Janssen, BS, RBT
• Ireland K Jenkins

• Home Health Agency in South Ogden, UT
• Providers in South Ogden, UT by specialty
• Home Health Agency in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.