Draper Dermatology, P.C.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

177611-1205 Issued in UT

Legal business name

DRAPER DERMATOLOGY, P.C.

Practice address

1325 W South Jordan Pkwy Ste 103
South Jordan, UT 84095-9060

Phone

(801) 232-6556

Fax

(801) 987-8467

NPI assigned

Sep 25, 2017

Last updated

Feb 8, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ryan Cooksey

Title

Practice Manager

Phone

(801) 232-6556

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Draper Dermatology, P.C.

  • Dermatology Physician
  • Evanston, WY
  • NPI 1942832159

  4688928526

  Same PAC ID

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• Direct secure messaging: larryderm@draperderm.emadirect.md

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Barbara Joelle Overby, DMSC, PA-C

  • Medical Physician Assistant
  • South Jordan, UT
  • NPI 1356963771
  Medicare reassignment Care Compare group NPD
• Heather B Allred, PA-C

  • Physician Assistant
  • Providence, UT
  • NPI 1104859149
  Medicare reassignment NPD
• Cory B Maughan, D.O.

  • MOHS-Micrographic Surgery Physician
  • Providence, UT
  • NPI 1598086720

  Dermatology

  Medicare reassignment NPD
• Paige Nelson, PA-C

  • Physician Assistant
  • South Jordan, UT
  • NPI 1649821281
  Medicare reassignment NPD
• Larry E Urry, M.D.

  • Dermatology Physician
  • South Jordan, UT
  • NPI 1083716955

  Single Specialty

  Medicare reassignment NPD
• Phillip Robert Rutledge, PA

  • Physician Assistant
  • Kemmerer, WY
  • NPI 1619592953

  UT

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1506297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581120000000",
    "number": "1093224818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1325 W SOUTH JORDAN PKWY STE 103",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840959060",
            "telephone_number": "801-232-6556",
            "fax_number": "801-987-8467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 W SOUTH JORDAN PKWY STE 103",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840959060",
            "telephone_number": "801-232-6556",
            "fax_number": "801-987-8467"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "190 Arrowhead Dr",
            "address_purpose": "LOCATION",
            "city": "Evanston",
            "state": "WY",
            "postal_code": "829309266",
            "country_code": "US",
            "telephone_number": "801-232-6556",
            "fax_number": "801-987-8467",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DRAPER DERMATOLOGY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-25",
        "last_updated": "2020-02-08",
        "certification_date": "2020-02-08",
        "status": "A",
        "authorized_official_last_name": "COOKSEY",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "801-232-6556"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "UT",
            "license": "177611-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1093224818",
            "state": "UT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "larryderm@draperderm.emadirect.md",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1325 W South Jordan Pkwy Ste 103",
            "city": "South Jordan",
            "state": "UT",
            "country_code": "US",
            "postal_code": "840959060",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Christopher Rae Dominguez, M.S. , AMFT
• James R Donahoo, DDS
• Donald R Call Jr DPM LLC
• Chelsea Doucet, LMSW, CSW
• Douglas S. Mehr, M.D., P.C. (Salt Lake Retina)
• Adrienne Duarte
• Taylor Dudley, DMD
• Allison Elizabeth Duesrch, LMFT
• Mallorie Duke
• Kimberly Palmer Dumas, APRN

• Dermatology Physician in South Jordan, UT
• Providers in South Jordan, UT by specialty
• Dermatology Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.