Individual provider Active NPI

Joseph W Vickroy, M.D.

  • Neurology Physician
  • SLC, UT
National Provider Identifier
1104818442
Registry record updated Dec 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
90183895-1205 Issued in UT
Practice address
1200 E 3900 S
SLC, UT 84124-1300
Phone
(801) 294-6907
Fax
(801) 294-6917
NPI assigned
Aug 22, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 16, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 90183895-1205 UT Primary

Addresses

Primary practice location

1200 E 3900 S
SLC, UT 84124-1300

Mailing address

2708 Gallivan Loop
Park City, UT 84060-7074
Phone (801) 599-1750

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100211000716 UT Practitioner - NeurologyPractitioner - Physical Medicine and Rehabilitation 2567505647 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NeurologyAlso: Physical Medicine and Rehabilitation
Education
University of California, San Diego School of Medicine, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1200 E 3900
Salt Lake City, UT 84124-1300
Phone (801) 268-7057

Hospital & facility affiliations

  • St Marks Hospital Inpatient rehabilitation facility, Salt Lake City, UT, CCN 46T047

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
90183895-1205UTMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Joseph W Vick Roy Jr MD PC Neurology CurrentSince Jan 19, 2010 Accepting new patients

Locations

1200 E 3900 S
Slc, UT 84124
Phone (801) 268-7111

Organizations & group practices 1

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.

Hospital & facility affiliations 2

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": "1124668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671148800000",
    "number": "1104818442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2708 GALLIVAN LOOP",
            "city": "PARK CITY",
            "state": "UT",
            "postal_code": "840607074",
            "telephone_number": "801-599-1750",
            "fax_number": "801-293-6828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 E 3900 S",
            "city": "SLC",
            "state": "UT",
            "postal_code": "841241300",
            "telephone_number": "801-294-6907",
            "fax_number": "801-294-6917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICKROY",
        "first_name": "JOSEPH",
        "middle_name": "W",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-22",
        "last_updated": "2022-12-16",
        "certification_date": "2022-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "UT",
            "license": "90183895-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in SLC, UT

Sources for this page

Verify at the official NPI Registry.