NPIMap

Individual provider Active NPI

David Crockett

  • Emergency Medicine Physician
  • Salt Lake City, UT
National Provider Identifier
1104351592
Registry record updated Nov 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
11680436-1205 Issued in UT
Practice address
University of Utah School of Medicine 30 N 1900 E 1C026
Salt Lake City, UT 84132-2147
Phone
(801) 581-2417
NPI assigned
Apr 24, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 59020 TN
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X 11680436-1205 UT Primary

Addresses

Primary practice location

University of Utah School of Medicine 30 N 1900 E 1C026
Salt Lake City, UT 84132-2147

Mailing address

975 E 3Rd St
Att: Velvet Green, Program Coordinator Em Residency
Chattanooga, TN 37403-2147
Phone (423) 778-7673

Other practice location 1

975 E 3rd St
ATT: Velvet Green, Program Coordinator EM Residency
Chattanooga, TN 37403-2147
Phone (423) 778-7673

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dcrockett447646@direct.med.utah.edu Direct University of Utah

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, UT, WY, TX4 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
I20190624003170 TN Practitioner - Emergency Medicine 6709163132 Reassigns benefits to 1 organization
I20200601002227 UT Practitioner - Emergency Medicine 6709163132 Reassigns benefits to 1 organization
I20200715000910 WY Practitioner - Emergency Medicine 6709163132 Reassigns benefits to 1 organization
I20201221000594 TX Practitioner - Emergency Medicine 6709163132 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Adult Services Current Accepting new patients
DHHS, PHS, Naihs, Shiprock Hospital CurrentSince Dec 7, 2020 Accepting new patients
University of Utah Adult Services CurrentSince May 31, 2020 Accepting new patients
Tennessee River Physicians, PLLC Emergency Medicine CurrentSince Apr 15, 2019 Accepting new patients
University of Utah Adult Services CurrentSince May 13, 2020 Accepting new patients
Tennessee River Physicians, PLLC Emergency Medicine CurrentSince Apr 15, 2019 Accepting new patients
University of Utah Adult Services CurrentSince May 13, 2020 Accepting new patients
Tennessee River Physicians, PLLC Emergency Medicine Current Accepting new patients
DHHS, PHS, Naihs, Shiprock Hospital CurrentSince Dec 7, 2020 Accepting new patients
University of Utah Adult Services Current Accepting new patients
DHHS IHS Phoenix Area Emergency Medicine CurrentSince Nov 9, 2021 Accepting new patients

Locations

975 E 3rd St
Chattanooga, TN 37403
Phone (423) 266-1499

16931 Rankin Ave
Dunlap, TN 37327
Phone (423) 949-5100

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

1200 College Dr
Rock Springs, WY 82901
Phone (307) 352-8352

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

Organizations & group practices 15

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 15

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Utah Adult Services 1,758 clinicians

Practice addresses (Care Compare)

1200 College Dr
Rock Springs, WY 82901-5868
Phone (801) 581-3495

50 N Medical Dr
Salt Lake City, UT 84132-0001
Phone (801) 581-2121

50 N Medical Dr
Salt Lake City, UT 84132-0100
Phone (801) 213-2995

Hospital & facility affiliations

  • University of Utah Hospital and Clinics Hospital, Salt Lake City, UT, CCN 460009
  • Holy Cross Hospital - Salt Lake Hospital, Salt Lake City, UT, CCN 460003

Merit-based Incentive Payment System (MIPS)

Final score
89.77 of 100Reported as group
Quality
91.47
Promoting interoperability
100
Improvement activities
40
Cost
74.42

NPI Registry JSON

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

{
    "created_epoch": "1492992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636675200000",
    "number": "1104351592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "975 E 3RD ST",
            "address_2": "ATT: VELVET GREEN, PROGRAM COORDINATOR EM RESIDENCY",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374032147",
            "telephone_number": "423-778-7673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "UNIVERSITY OF UTAH SCHOOL OF MEDICINE 30 N 1900 E 1C026",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841322147",
            "telephone_number": "801-581-2417"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "975 E 3rd St",
            "address_2": "ATT: Velvet Green, Program Coordinator EM Residency",
            "address_purpose": "LOCATION",
            "city": "Chattanooga",
            "state": "TN",
            "postal_code": "374032147",
            "country_code": "US",
            "telephone_number": "423-778-7673",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CROCKETT",
        "first_name": "DAVID",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-24",
        "last_updated": "2021-11-12",
        "certification_date": "2021-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TN",
            "license": "59020",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "UT",
            "license": "11680436-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dcrockett447646@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.