Individual provider Active NPI

Todd Hamblin

  • Family Nurse Practitioner
  • Logan, UT
National Provider Identifier
1093092678
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
5554739-4405 Issued in UT
Practice address
1350 N 500 E
Logan, UT 84341-2400
Phone
(435) 716-1130
Fax
(435) 719-1131
NPI assigned
Nov 9, 2011
Last updated
Mar 17, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 5554739-4405 UT Primary

Addresses

Primary practice location

1350 N 500 E
Logan, UT 84341-2400

Mailing address

PO Box 27128
Salt Lake City, UT 84127-0128
Phone (435) 716-1130

Other practice location 1

1055 N 500 W
Suite 202
Provo, UT 84604-3305
Phone (801) 374-2367

Other practice location 2

1350 N 500 E
Logan, UT 84341-2400
Phone (435) 716-1130

Other practice location 3

1055 N 500 W
Suite 202
Provo, UT 84604-3305
Phone (801) 374-2367

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT, ID2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20120305000002 UT Practitioner - Nurse Practitioner 5890954283 Reassigns benefits to 3 organizations
I20190320003088 ID Practitioner - Nurse Practitioner 5890954283 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ihc Health Services IncGroup PAC ID 1850209420, shared by 68 NPIs, 3,948 clinicians

Practice addresses (Care Compare)

1034 N 500
Uvh Phys Billing
Provo, UT 84604-3380
Phone (801) 357-7850

1350 N 500
Logan, UT 84341-2400
Phone (435) 716-1770

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
5554739-4405UTMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services, Inc. CurrentSince May 7, 2014 Accepting new patients
Ihc Health Services Inc CurrentSince May 7, 2014 Accepting new patients
Ihc Health Services Inc CurrentSince Oct 1, 2017 Accepting new patients
Molina Care Connections, LLC. CurrentSince Jan 14, 2019 Accepting new patients
Molina Healthcare of Utah Inc Family CurrentSince Nov 26, 2017 Accepting new patients
Ihc Health Services Inc Current Accepting new patients
Ihc Health Services Inc Current Accepting new patients
Ihc Health Services Inc Past Accepting new patients

Locations

200 Oceangate
Ste 100
Long Beach, CA 90802
Phone (562) 435-3666

950 W Bannock St
Ste 1100
Boise, ID 83702
Phone (201) 293-7689

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

201 W Layton Pkwy
Ste 2A
Layton, UT 84041
Phone (801) 387-7185

1281 N 600 E
Logan, UT 84341
Phone (435) 716-6400

7050 S Union Park Ave
Ste 200
Midvale, UT 84047
Phone (562) 549-3966

1350 N 500 E
North Logan, UT 84341
Phone (435) 716-2800

4403 Harrison Blvd
Ste 1670
Ogden, UT 84403
Phone (801) 387-7125

1034 N 500 W
Provo, UT 84604
Phone (801) 362-4119

400 C St
Salt Lake Cty, UT 84143
Phone (435) 688-4080

Interoperability endpoints

  • FHIR API: https://epicproxy.et1057.epichosted.com/FHIRProxy/api/FHIR/R4/

Organizations & group practices 8

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 5

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": "1320796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1093092678",
    "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": "435-716-1130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 N 500 E",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843412400",
            "telephone_number": "435-716-1130",
            "fax_number": "435-719-1131"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1055 N 500 W",
            "address_2": "Suite 202",
            "address_purpose": "LOCATION",
            "city": "Provo",
            "state": "UT",
            "postal_code": "846043305",
            "country_code": "US",
            "telephone_number": "801-374-2367",
            "fax_number": "801-429-8015",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1350 N 500 E",
            "address_purpose": "LOCATION",
            "city": "Logan",
            "state": "UT",
            "postal_code": "843412400",
            "country_code": "US",
            "telephone_number": "435-716-1130",
            "fax_number": "435-719-1131",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1055 N 500 W",
            "address_2": "Suite 202",
            "address_purpose": "LOCATION",
            "city": "Provo",
            "state": "UT",
            "postal_code": "846043305",
            "country_code": "US",
            "telephone_number": "801-374-2367",
            "fax_number": "801-429-8015",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAMBLIN",
        "first_name": "TODD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-11-09",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "UT",
            "license": "5554739-4405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Logan, UT

Sources for this page

Verify at the official NPI Registry.