Bridge Utah Medical Group

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

BRIDGE UTAH MEDICAL GROUP

Practice address

1015 E 100 N
Logan, UT 84321-4873

Phone

(888) 221-0423

Fax

(888) 221-9816

NPI assigned

Jan 26, 2018

Last updated

Mar 14, 2019By 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

Cameron G Peterson, MD

Title

Chief Medical Officer, Managing Par

Phone

(801) 598-8337

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

Practitioners 1

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.

• Jaron Andrew Stout, PHARMD

  • Geriatric Pharmacist
  • Logan, UT
  • NPI 1164912374
  NPD (past)

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

{
    "created_epoch": "1516924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552521600000",
    "number": "1104324904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1468",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840111468",
            "telephone_number": "888-853-8973",
            "fax_number": "888-959-9385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 E 100 N",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843214873",
            "telephone_number": "888-221-0423",
            "fax_number": "888-221-9816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGE UTAH MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-26",
        "last_updated": "2019-03-14",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "CAMERON",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER, MANAGING PAR",
        "authorized_official_telephone_number": "801-598-8337",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0000",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bral Holdings LLC (RT MedMobile)
• Shea Davin Brendel, LAT, ATC
• Ariana Brenes
• Amy Bresley, ATC, LAT
• Megan E Bressel, PT
• Kelsey Nicole Brimhall
• Katerina Briscoe
• Lee S Broadbent, MD
• Michael L Broadbent, D.O.
• Ashley Carolina Brog, LCSW

• Physical Medicine & Rehabilitation Physician in Logan, UT
• Providers in Logan, UT by specialty
• Physical Medicine & Rehabilitation Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.