NPIMap

Individual provider Active NPI

Robert Brown Woolley, MD

  • Nephrology Physician
  • Provo, UT
National Provider Identifier
1104995109
Registry record updated Feb 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
269743-1205 Issued in UT
Practice address
1055 N 300 W Ste 210
Provo, UT 84604-3374
Phone
(801) 357-0280
Fax
(801) 377-2810
NPI assigned
Nov 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 01057426A IN
Aerospace Medicine Physician 2083A0100X 01057426A IN
Nephrology Physician 207RN0300X 269743-1205 UT Primary

Addresses

Primary practice location

1055 N 300 W Ste 210
Provo, UT 84604-3374

Mailing address

PO Box 27128
Salt Lake City, UT 84127-0128

Other practice location 1

4700 Las Vegas Blvd N
Nellis AFB, NV 89191-6600
Phone (702) 653-2273

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250116001832 UT Practitioner - Nephrology 3678756442 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
University of Oklahoma College of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Practice addresses (Care Compare)

1055 N 300
Suite 210
Provo, UT 84604-3374
Phone (801) 357-0280

Hospital & facility affiliations

  • 462543 SRS- Payson, LLC Dialysis facility, Payson, UT, CCN 462543
  • 462504 SRS-Provo, LLC Dialysis facility, Provo, UT, CCN 462504
  • Intermountain Health Utah Valley Hospital Hospital, Provo, UT, CCN 460001
  • American Fork Hospital Hospital, American Fork, UT, CCN 460023
  • Intermountain Health Heber Valley Hospital Hospital, Heber City, UT, CCN 461307
  • Intermountain Health Sanpete Valley Hospital Hospital, Mount Pleasant, UT, CCN 461303
  • Castleview Hospital Hospital, Price, UT, CCN 460011

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
269743-1205UTMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services Inc CurrentSince Mar 2, 2025 Accepting new patients
Ihc Health Services, Inc. CurrentSince Mar 2, 2025 Accepting new patients
Ihc Health Services Inc Current Accepting new patients

Locations

700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555

1055 N 300 W
Ste 210
Provo, UT 84604
Phone (801) 357-0280

5169 S Cottonwood St
Ste 320
Salt Lake City, UT 84107
Phone (801) 507-2531

Organizations & group practices 3

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 9

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": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740009600000",
    "number": "1104995109",
    "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",
            "fax_number": "801-377-2810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 N 300 W STE 210",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043374",
            "telephone_number": "801-357-0280",
            "fax_number": "801-377-2810"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4700 Las Vegas Blvd N",
            "address_purpose": "LOCATION",
            "city": "Nellis AFB",
            "state": "NV",
            "postal_code": "891916600",
            "country_code": "US",
            "telephone_number": "702-653-2273",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WOOLLEY",
        "first_name": "ROBERT",
        "middle_name": "BROWN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-06",
        "last_updated": "2025-02-20",
        "certification_date": "2025-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "IN",
            "license": "01057426A",
            "primary": false
        },
        {
            "code": "2083A0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Aerospace Medicine",
            "state": "IN",
            "license": "01057426A",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "UT",
            "license": "269743-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Provo, UT

Sources for this page

Verify at the official NPI Registry.