NPIMap

Individual provider Active NPI

Michael W. Mangelson, M.D.

  • Urology Physician
  • Salt Lake City, UT
National Provider Identifier
1114944790
Registry record updated Dec 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
291501-1205 Issued in UT
Practice address
389 S 900 E
Salt Lake City, UT 84102
Phone
(385) 282-2000
Fax
(385) 282-2001
NPI assigned
Jul 17, 2006
Last updated
Dec 4, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 291501-1205 UT Primary

Addresses

Primary practice location

389 S 900 E
Salt Lake City, UT 84102

Mailing address

PO Box 27128
Salt Lake City, UT 84127-0128
Phone (385) 282-2000

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
I20060111000145 UT Practitioner - Urology 6709809288 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Creighton University School of Medicine, 1989
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

Practice addresses (Care Compare)

325 8TH Ave
Salt Lake City, UT 84143-0001
Phone (801) 408-3617

389 S 900
Salt Lake City, UT 84102-2310

5121 S Cottonwood St
Murray, UT 84107-5701

5131 S Cottonwood St
Murray, UT 84107-5701
Phone (801) 507-3888

700 S Hwy 99
Suite 3
Fillmore, UT 84631-5137
Phone (801) 357-4600

8 TH Ave and C St
Salt Lake City, UT 84143-0001
Phone (801) 408-1100

9660 S 1300
Sandy, UT 84094-3762

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
291501-1205UTMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services, Inc. CurrentSince Dec 1, 1996 Accepting new patients
Ihc Health Services Inc CurrentSince Dec 1, 1996 Accepting new patients
Ihc Health Services Inc CurrentSince Apr 2, 1997 Accepting new patients
Ihc Health Services Inc Family Medicine Current Accepting new patients
Ihc Health Services Inc Current Accepting new patients
Ihc Health Services Inc Past Accepting new patients

Locations

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

389 S 900 E
Slc, UT 84102
Phone (385) 282-2000

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

Organizations & group practices 6

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 5

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": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354579200000",
    "number": "1114944790",
    "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": "385-282-2000",
            "fax_number": "385-282-2001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "389 S 900 E",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "84102",
            "telephone_number": "385-282-2000",
            "fax_number": "385-282-2001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGELSON",
        "first_name": "MICHAEL",
        "middle_name": "W.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2012-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "UT",
            "license": "291501-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.