Individual provider Active NPI

Kerry Robert Baum Jr., MD

  • Surgery Physician
  • Roosevelt, UT
National Provider Identifier
1093004202
Registry record updated Sep 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
8414666-1205 Issued in UT
Practice address
250 W 300 N
Uintah Basin Medical Center
Roosevelt, UT 84066
Phone
(435) 722-4691
Fax
(435) 722-6103
NPI assigned
Mar 29, 2011
Last updated
Sep 23, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 8414666-1205 UT Primary

Addresses

Primary practice location

250 W 300 N
Uintah Basin Medical Center
Roosevelt, UT 84066

Mailing address

250 W 300 N
Uintah Basin Medical Center
Roosevelt, UT 84066
Phone (435) 722-4691

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
I20160729000818 UT Practitioner - General Surgery 4284866344 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Michigan Medical School, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Uintah Basin Medical CenterGroup PAC ID 0244131944, 62 clinicians
Northeastern Utah Medical GroupGroup PAC ID 2961496609, 52 clinicians

Practice addresses (Care Compare)

210 W 300
Roosevelt, UT 84066-2336

250 W 300
Roosevelt, UT 84066-2336

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.32 of 100Reported as apm
Quality
71.89
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy23
Hernia repair - groin (open)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux15
Removal of tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Uintah Basin Medical Center CurrentSince Jan 1, 2017 Accepting new patients
Northeastern Utah Medical Group Surgery CurrentSince Jul 14, 2016 Accepting new patients
Uintah Basin Medical Center CurrentSince Jan 1, 2017 Accepting new patients
Northeastern Utah Medical Group Surgery CurrentSince Jul 14, 2016 Accepting new patients

Locations

50 E 200 S
Duchesne, UT 84021
Phone (435) 738-2426

210 W 300 N
Roosevelt, UT 84066
Phone (435) 722-4691

210 W 300 N
Ste 753
Roosevelt, UT 84066

250 W 300 N
Roosevelt, UT 84066
Phone (435) 722-4691

250 W 300 N
#752
Roosevelt, UT 84066
Phone (435) 722-4691

379 N 500 W
Vernal, UT 84078
Phone (435) 781-2030

405 N 500 W
Vernal, UT 84078
Phone (435) 781-2335

475 N 500 W
Vernal, UT 84078
Phone (435) 781-2030

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1301356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1474588800000",
    "number": "1093004202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 W 300 N",
            "address_2": "UINTAH BASIN MEDICAL CENTER",
            "city": "ROOSEVELT",
            "state": "UT",
            "postal_code": "84066",
            "telephone_number": "435-722-4691",
            "fax_number": "435-722-6103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 W 300 N",
            "address_2": "UINTAH BASIN MEDICAL CENTER",
            "city": "ROOSEVELT",
            "state": "UT",
            "postal_code": "84066",
            "telephone_number": "435-722-4691",
            "fax_number": "435-722-6103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUM",
        "first_name": "KERRY",
        "middle_name": "ROBERT",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-03-29",
        "last_updated": "2016-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "UT",
            "license": "8414666-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roosevelt, UT

Sources for this page

Verify at the official NPI Registry.