NPIMap

Individual provider Active NPI

Kaytelin G. Suslavich, MD

  • Emergency Medicine Physician
  • Salt Lake City, UT
National Provider Identifier
1114582392
Registry record updated Dec 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
11887192-1205 Issued in UT
Practice address
30 N 1900 E RM 1C026
Salt Lake City, UT 84132-0001
Phone
(801) 581-2272
NPI assigned
May 3, 2019
Last updated
Dec 8, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 11887192-1205 UT Primary

Addresses

Primary practice location

30 N 1900 E RM 1C026
Salt Lake City, UT 84132-0001

Mailing address

30 N 1900 E RM 1C026
Salt Lake City, UT 84132-0001
Phone (801) 581-2272

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ksuslavich352173@direct.med.utah.edu Direct University of Utah

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
I20220919002118 UT Practitioner - Emergency Medicine 3173941044 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Tufts University School of Dental Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ihc Health Services IncGroup PAC ID 1850209420, shared by 68 NPIs, 3,948 clinicians
Utah Emergency PhysiciansGroup PAC ID 1153307277, 151 clinicians

Practice addresses (Care Compare)

3850 Canyons Resort Dr
Park City, UT 84098-6546
Phone (435) 615-2235

5121 S Cottonwood St
Salt Lake City, UT 84107-5701
Phone (801) 507-9700

905 N 1000
Tremonton, UT 84337-9356
Phone (435) 207-4500

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11887192-1205UTMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services, Inc. CurrentSince Jan 31, 2023 Accepting new patients
University of Utah Adult Services Current Accepting new patients
University of Utah Pediatric Services CurrentSince Mar 16, 2024 Accepting new patients
University of Utah Adult Services CurrentSince Dec 30, 2023 Accepting new patients
University of Utah Pediatric Services Current Accepting new patients
Utah Emergency Physicians Emergency Medicine CurrentSince Aug 1, 2022 Accepting new patients
University of Utah Adult Services CurrentSince Dec 30, 2023 Accepting new patients
Ihc Health Services Inc CurrentSince Apr 12, 2025 Accepting new patients
Ihc Health Services Inc Family Medicine Current Accepting new patients
Ihc Health Services Inc CurrentSince Jan 31, 2023 Accepting new patients
University of Utah Pediatric Services CurrentSince Mar 16, 2024 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

5121 S Cottonwood St
Salt Lake Cty, UT 84107
Phone (801) 408-8998

100 N Mario Capecchi Dr
Slc, UT 84113
Phone (801) 587-7109

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

9385 S Snowbird Center Dr
Snowbird, UT 84092
Phone (801) 587-7109

5171 S Cottonwood St
South Salt Lake, UT 84107
Phone (801) 507-4000

1380 E Medical Center Dr
St George, UT 84790
Phone (435) 251-2992

1380 E Medical Center Dr
#P
St George, UT 84790
Phone (435) 251-2355

905 N 1000 W
Tremonton, UT 84337
Phone (435) 207-4500

Interoperability endpoints

  • Direct secure messaging: ksuslavich352173@direct.med.utah.edu

Organizations & group practices 12

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

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": "1556841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733616000000",
    "number": "1114582392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 N 1900 E RM 1C026",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841320001",
            "telephone_number": "801-581-2272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 N 1900 E RM 1C026",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841320001",
            "telephone_number": "801-581-2272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUSLAVICH",
        "first_name": "KAYTELIN",
        "middle_name": "G.",
        "name_prefix": "Ms.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-03",
        "last_updated": "2024-12-08",
        "certification_date": "2024-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "UT",
            "license": "11887192-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ksuslavich352173@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.