Individual provider Active NPI

Charles Reese Morrison, M.D.

  • Family Medicine Physician
  • Park City, UT
National Provider Identifier
1083669204
Registry record updated Aug 31, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5523050-1205 Issued in UT
Practice address
1665 Bonanza Dr
Park City, UT 84060-5127
Phone
(435) 649-7640
Fax
(435) 649-1365
NPI assigned
May 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Legal Medicine 173000000X 5525050-1205 UT
Family Medicine Physician 207Q00000X 5523050-1205 UT Primary

Addresses

Primary practice location

1665 Bonanza Dr
Park City, UT 84060-5127

Mailing address

PO Box 27128
Salt Lake City, UT 84127-0128
Phone (801) 491-6482

Other identifiers 1

IdentifierTypeStateIssuer
D5365MedicaidUT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
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 1

Enrollment IDStateProvider typePAC IDDetails
I20040420001567 UT Practitioner - Family Practice 4981690617 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Utah School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Practice addresses (Care Compare)

1493 Lowell Ave
Park City, UT 84060-5116
Phone (435) 615-2235

1750 Sidewater Dr
Park City, UT 84060-7570
Phone (435) 649-7640

3249 N 1200
Lehi, UT 84043-9772
Phone (801) 753-4300

354 W Crossroads Blvd
Saratoga Springs, UT 84045-5506
Phone (801) 341-5295

354 W State Rd
Suite 73
Saratoga Springs, UT 84045-5506
Phone (801) 341-5200

3723 W 1200
Riverton, UT 84065-7296
Phone (801) 535-7035

3723 W 12600
Riverton, UT 84065-7296

3850 Canyons Resort Dr
Park City, UT 84098-6546
Phone (435) 615-2235

4000 Canyons Resort Dr
Park City, UT 84098-6546
Phone (435) 615-2235

454 E Medical Way
Heber City, UT 84032-1391
Phone (435) 654-2500

700 S Hwy 99
Suite 3
Fillmore, UT 84631-5137
Phone (801) 357-4600

98 N 1100
American Fork, UT 84003-2940

Hospital & facility affiliations

  • Park City Hospital Hospital, Park City, UT, CCN 460057

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5525050-1205UTMDLegal Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services Inc CurrentSince Aug 1, 2012 Accepting new patients
Ihc Health Services Inc Current Accepting new patients
Ihc Health Services, Inc. CurrentSince Aug 1, 2012 Accepting new patients
Joshua M Hickman M D P C Past Accepting new patients

Locations

700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555

4000 Canyons Resort Dr
Park City, UT 84098
Phone (435) 615-2235

750 Round Valley Dr
Ste 201
Park City, UT 84060
Phone (435) 649-7640

1665 Bonanza Dr
Park City, UT 84060
Phone (435) 649-7640

Organizations & group practices 4

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.

Hospital & facility affiliations 1

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": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346371200000",
    "number": "1083669204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27128",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841270128",
            "telephone_number": "801-491-6482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1665 BONANZA DR",
            "city": "PARK CITY",
            "state": "UT",
            "postal_code": "840605127",
            "telephone_number": "435-649-7640",
            "fax_number": "435-649-1365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORRISON",
        "first_name": "CHARLES",
        "middle_name": "REESE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-24",
        "last_updated": "2012-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "",
            "desc": "Legal Medicine",
            "state": "UT",
            "license": "5525050-1205",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "5523050-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D5365",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Park City, UT

Sources for this page

Verify at the official NPI Registry.