NPIMap

Individual provider Active NPI

Mina Gohari, M.D.

  • Family Medicine Physician
  • Salt Lake City, UT
National Provider Identifier
1083824940
Registry record updated Nov 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
7711982-1205 Issued in UT
Practice address
1160 E 3900 S
Ste G200
Salt Lake City, UT 84124-1202
Phone
(801) 268-7766
Fax
(201) 270-3395
NPI assigned
May 22, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hospice and Palliative Medicine (Family Medicine) Physician 207QH0002X 4301088182 MI
Family Medicine Physician 207Q00000X 7711982-1205 UT Primary

Addresses

Primary practice location

1160 E 3900 S
Ste G200
Salt Lake City, UT 84124-1202

Mailing address

PO Box 742382
Atlanta, GA 30374-2382

Other identifiers 1

IdentifierTypeStateIssuer
000057838OtherUTPTAN

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
I20101110000397 UT Practitioner - Family Practice 4486799038 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Marks Physician Billing LLCGroup PAC ID 6103061072, 8 clinicians

Practice addresses (Care Compare)

1275 E Fort Union Blvd
Suite 150
Cottonwood Heights, UT 84047-1897
Phone (801) 268-7766

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
80.72 of 100Reported as individual
Quality
77.45
Improvement activities
40
Cost
65.82

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
7711982-1205UTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Mark'S Physician Billing, LLC CurrentSince Jun 1, 2013 Accepting new patients
Mobile MBS Inc. PastSince Aug 20, 2011 Accepting new patients
Ma Bo Inc Family Medicine Past Accepting new patients

Locations

2000 Health Park Dr
Brentwood, TN 37027
Phone (615) 372-5426

1275 E Fort Union Blvd
Ste 150
Cottonwood Heights, UT 84047
Phone (801) 268-7766

1160 E 3900 S
Ste G200
Slc, UT 84124
Phone (801) 268-7766

Networks

  • UT PPO D-SNP
  • UT PPO

Organizations & group practices 3

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 8

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": "1179792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606262400000",
    "number": "1083824940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 742382",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303742382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1160 E 3900 S",
            "address_2": "STE G200",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841241202",
            "telephone_number": "801-268-7766",
            "fax_number": "201-270-3395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOHARI",
        "first_name": "MINA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-22",
        "last_updated": "2020-11-25",
        "certification_date": "2020-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QH0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": "MI",
            "license": "4301088182",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "7711982-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "000057838",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.