Individual provider Active NPI

Johnnie V Cook, MD

  • Family Medicine Physician
  • Layton, UT
National Provider Identifier
1104934280
Registry record updated Jun 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
921874741205 Issued in UT
Practice address
2075 N 1200 W
Layton, UT 84041-1616
Phone
(801) 779-6200
NPI assigned
Aug 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 921874741205 UT Primary

Addresses

Primary practice location

2075 N 1200 W
Layton, UT 84041-1616

Mailing address

PO Box 27128
Salt Lake City, UT 84127-0128
Phone (801) 779-6200

Other identifiers 1

IdentifierTypeStateIssuer
1467597005MedicaidUT

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
I20060113000714 UT Practitioner - Family Practice 5193749380 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Utah School of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tanner Memorial ClinicGroup PAC ID 4284547985, 251 clinicians

Practice addresses (Care Compare)

2121 N 1700
Layton, UT 84041-8803
Phone (801) 773-4840

Hospital & facility affiliations

  • Atlas Home Care Home health agency, Layton, UT, CCN 467232
  • Intermountain Health McKay-Dee Hospital Hospital, Ogden, UT, CCN 460004
  • Holy Cross Hospital-Davis Hospital, Layton, UT, CCN 460041
  • Intermountain Health Layton Hospital Hospital, Layton, UT, CCN 460061

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
921874741205UTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tanner Memorial Clinic CurrentSince Apr 1, 2015 Accepting new patients
Ihc Health Services Inc Family Medicine Current Accepting new patients
Ihc Health Services Inc CurrentSince Nov 4, 2019 Accepting new patients
Tanner Memorial Clinic CurrentSince Apr 1, 2015 Accepting new patients

Locations

425 S 100 W
Layton, UT 84041
Phone (801) 682-8708

4403 Harrison Blvd
Ogden, UT 84403
Phone (801) 387-2800

Networks

  • UT PPO D-SNP
  • UT PPO

Interoperability endpoints

  • Direct secure messaging: johnnie.cook.p1@direct.tannerclinic.nextgenshare.com

Organizations & group practices 4

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 4

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": "1156723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213833600000",
    "number": "1104934280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27128",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841270128",
            "telephone_number": "801-779-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2075 N 1200 W",
            "city": "LAYTON",
            "state": "UT",
            "postal_code": "840411616",
            "telephone_number": "801-779-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOK",
        "first_name": "JOHNNIE",
        "middle_name": "V",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-28",
        "last_updated": "2008-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "921874741205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1467597005",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Layton, UT

Sources for this page

Verify at the official NPI Registry.