NPIMap

Individual provider Active NPI

Douglas Gavin Kondo, M.D.

  • Child & Adolescent Psychiatry Physician
  • Salt Lake City, UT
National Provider Identifier
1083703284
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
6313601-1205 Issued in UT
Practice address
501 S Chipeta Way
Salt Lake City, UT 84108-1222
Phone
(801) 585-1575
NPI assigned
Oct 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 6313601-1205 UT
Child & Adolescent Psychiatry Physician 2084P0804X 6313601-1205 UT Primary

Addresses

Primary practice location

501 S Chipeta Way
Salt Lake City, UT 84108-1222

Mailing address

PO Box 413076
Salt Lake City, UT 84141-3076
Phone (801) 213-3900

Other identifiers 2

IdentifierTypeStateIssuer
11725447OtherUTCAQH NUMBER
6313601-1205OtherUTUTAH MEDICAL LICENSE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dkondo49496@direct.med.utah.edu Direct University of Utah

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070309000269 UT Practitioner - Pediatric MedicinePractitioner - Psychiatry 9739142332 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pediatric MedicineAlso: Psychiatry
Education
University of Utah School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

501 S Chipeta Way
Salt Lake City, UT 84108-1222
Phone (801) 585-1575

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
6313601-1205UTMDChild & Adolescent Psychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Behavioral Health Services CurrentSince Feb 2, 2017 Accepting new patients
University of Utah Pediatric Acuity Care CurrentSince May 26, 2019 Accepting new patients
University of Utah Pediatric Behavioral Health Services CurrentSince May 26, 2019 Accepting new patients
University of Utah Behavioral Health Services Psychiatry Current Accepting new patients
University of Utah Behavioral Health Services CurrentSince Feb 2, 2017 Accepting new patients
University of Utah Pediatric Acuity Care Current Accepting new patients
University of Utah Acuity Care Services CurrentSince May 26, 2019 Accepting new patients
University of Utah Acuity Care Services Current Accepting new patients
University of Utah Acuity Care Services CurrentSince May 26, 2019 Accepting new patients
University of Utah Pediatric Behavioral Health Services CurrentSince May 26, 2019 Accepting new patients
University of Utah Pediatric Acuity Care CurrentSince May 26, 2019 Accepting new patients
Triumph LLC Past Accepting new patients

Locations

2250 N Miller Campus Dr
Lehi, UT 84048
Phone (385) 531-1000

250 E 200 S
Ste 1350
Salt Lake City, UT 84111
Phone 80158763362003

525 E 100 S
Ste 500
Salt Lake City, UT 84102
Phone (801) 519-7190

501 S Chipeta Way
Slc, UT 84108
Phone (801) 581-7951

650 S Komas Dr
Ste 208
Slc, UT 84108
Phone (801) 585-1212

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

100 N Mario Capecchi Dr
Slc, UT 84113
Phone (801) 587-7109

Interoperability endpoints

  • Direct secure messaging: dkondo49496@direct.med.utah.edu

Organizations & group practices 12

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 3

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": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1083703284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 413076",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841413076",
            "telephone_number": "801-213-3900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 S CHIPETA WAY",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841081222",
            "telephone_number": "801-585-1575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KONDO",
        "first_name": "DOUGLAS",
        "middle_name": "GAVIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2023-03-07",
        "certification_date": "2021-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "UT",
            "license": "6313601-1205",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "UT",
            "license": "6313601-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH NUMBER",
            "identifier": "11725447",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UTAH MEDICAL LICENSE",
            "identifier": "6313601-1205",
            "state": "UT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dkondo49496@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.