Frederic M Civish III

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

184916-1205 Issued in UT

Practice address

3534 S 6000 W
West Valley, UT 84128-2610

Phone

(801) 969-6264

Fax

(801) 969-6333

NPI assigned

Aug 30, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Family Practice

Education

University of Utah School of Medicine, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Hunter Medical Center IncGroup PAC ID 3678461951, 9 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Holy Cross Hospital-Jordan Valley Hospital, West Jordan, UT, CCN 460051
• Intermountain Medical Center Hospital, Murray, UT, CCN 460010

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• UT PPO
• UT PPO D-SNP

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.

• Hunter Medical Center, Inc

  dba Jordan Meadows Medical Center.

  • Family Medicine Physician
  • West Jordan, UT
  • NPI 1205957131
  Medicare reassignment Care Compare group NPD Authorized official
• Hunter Medical Center, Inc

  dba Jordan Meadows Medical Center

  • Family Medicine Physician
  • West Valley, UT
  • NPI 1194860569
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Catholic Health Initiatives Colorado

  dba Holy Cross Hospital - Jordan Valley

  • General Acute Care Hospital
  • West Jordan, UT
  • NPI 1801591391
  Care Compare affiliation
• Ihc Health Services, Inc.

  dba Intermountain Health Intermountain Medical Center

  • General Acute Care Hospital
  • Murray, UT
  • NPI 1043220650
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485129600000",
    "number": "1124137278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3354 W 7800 S",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840884506",
            "telephone_number": "801-282-2677",
            "fax_number": "801-282-4654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3534 S 6000 W",
            "city": "WEST VALLEY",
            "state": "UT",
            "postal_code": "841282610",
            "telephone_number": "801-969-6264",
            "fax_number": "801-969-6333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CIVISH",
        "first_name": "FREDERIC",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2017-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "184916-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Century Dental West LC
• Benson Miller Chapman
• Jenna Chapman
• Kaleb Chapman
• Jae Eun Cho, DMD
• Dorothea Clayton, LCSW
• Briella Coca
• Alex Daniel Colon Moya, PHARMD
• Confederated Tribes of the Goshute Reservation (Sacred Circle Healthcare)
• Costco Wholesale Corporation (Costco Hearing Aid #622)

• Family Medicine Physician in West Valley, UT
• Providers in West Valley, UT by specialty
• Family Medicine Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.