Premier Family Medical - Vineyard
Organization Active NPI Family Medicine Physician · Vineyard, UT
NPI 1093301566 · NPPES record last updated Mar 22, 2024
Key facts
- NPI
- 1093301566
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- PREMIER FAMILY MEDICAL - VINEYARD
- Practice address
- 707 E Mill Rd Ste 303
Vineyard, UT 84059-5730 - Phone
- (801) 224-1300
- Fax
- (801) 225-3236
- NPI assigned
- Dec 17, 2020
- Organization subpart
- Yes
- Parent organization (as reported)
- PREMIER FAMILY MEDICAL
Authorized official
- Name
- Heather Guymon
- Title
- Credentialing Specialist
- Phone
- (801) 769-2571
Other NPIs on the same Medicare enrollment 11
Corporate family (same tax ID) 5
Practitioners 10
-
Bethany Green, DNP, MSN-ED., FNP-C
-
Mark K Hafen, D.O.
-
Cory Hester, A.P.R.N.
-
Rachel Maria Hogan, FNP
-
Steven Michael Ruiz, PA-C
-
Jill Bergeson Barkdull, M.D.
-
Roger D. Brockbank, M.D.
-
Michael S Curtis, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 46D2156902 | Premier Family Medical - Vineyard | Certificate of waiver | Oct 25, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130710000079 | UT | Part B Supplier - Clinic/Group Practice | 7416197785 |
Receives reassigned benefits from 106 practitioners 12 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Lindon, UT; Vineyard, UT; Saratoga Springs, UT; Pleasant Grove, UT; Lehi, UT; Eagle Mountain, UT; American Fork, UT |
National Provider Directory
- Tax ID family
- Premier Family Medical - Traverse Mountain
- Part of
- Premier Family Medical - Traverse Mountain
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
707 E Mill Rd Ste 303
Vineyard, UT 84059-5730
Mailing address
275 W 200 N
Lindon, UT 84042-5009
Phone (801) 769-2560
Other names
- Premier Family Medical - Vineyard
Other providers in Vineyard, UT
- Bjorn A. Nordstrom
- Lauren Nicole Olinger
- Tyler James Ostlund
- Edward Parry
- Travis Russell Peterson
- Ian Kyle Rader
- Hilma Karen Rodriguez
- Shruti B. Sanghvi
- Tom Sitake
- Jennifer Lin Sorge
All providers in Vineyard, UT · Family Medicine Physician in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 22, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.