Tala'at Al-Shuqairat, MD
Individual provider Active NPI Pulmonary Disease Physician · Salem, UT
NPI 1104875574 · NPPES record last updated Nov 27, 2023
Key facts
- NPI
- 1104875574
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pulmonary Disease Physician 207RP1001X
- License
- 60083151205 (UT)
- Practice address
- 555 W Sr 164
Salem, UT 84653-1666 - Phone
- (801) 465-4813
- Fax
- (801) 812-5433
- NPI assigned
- May 10, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 9
Medicare Care Compare profile
- Specialty
- Pulmonary Disease
- Education
- Other, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Revere Health PC
Practice addresses (Care Compare)
555 W Sr
Suite 164
Salem, UT 84653
Phone (801) 465-4813
Hospital & facility affiliations
- Symbii Home Health South
- Intermountain Health Utah Valley Hospital
- Intermountain Health Spanish Fork Hospital
- Castleview Hospital
- American Fork Hospital
- Intermountain Health Sevier Valley Hospital
- Utah Valley Specialty Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060809000497 | UT | Practitioner - Pulmonary Disease |
7113920299 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60083151205 | UT | MD | Pulmonary Disease Physician |
Practice roles (2 of 4)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Revere Health PC | Current |
Accepting new patients | |
| Revere Health PC | Current |
Accepting new patients |
Locations
2183 W Main St
Ste A208
Lehi, UT 84043
Phone (801) 418-9167
1055 N 500 W
Ste 212
Provo, UT 84604
Phone (801) 374-2362
1055 N 500 W
Provo, UT 84604
Phone (801) 429-8000
555 W State Road 164
Salem, UT 84653
Phone (801) 465-4896
306 W River Bend Ln
Sundance, UT 84604
Phone (801) 226-5838
Networks
- UT PPO
- UT PPO D-SNP
Interoperability endpoints
- talaatalshuqairat@cuccu.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Care Medicine (Internal Medicine) Physician | 207RC0200X | 60083151205 | UT | |
| Sleep Medicine (Internal Medicine) Physician | 207RS0012X | 60083151205 | UT | |
| Pulmonary Disease Physician | 207RP1001X | 60083151205 | UT | Yes |
Addresses
Primary practice location
555 W Sr 164
Salem, UT 84653-1666
Mailing address
1055 N 500 W
Attn: Credentialing
Provo, UT 84604-3305
Phone (801) 354-8225
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 870281028000 | Medicaid | UT | |
| 000059100 | Other | UT | MEDICARE |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | medreview@reverehealth.com | Revere Health PC |
Other providers in Salem, UT
- Advanced Vein and Vascular of Utah Valley LLC
- Ahc of Salem LLC
- Courtney Amber Allred
- Jannelyse Allred
- Amber Lynn Anderson
- Karen McCuistion Anderson
- Darren H Averett
All providers in Salem, UT · Pulmonary Disease 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 Nov 27, 2023. 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.
- Order and Referring (CMS).
- 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.