Lance Dustin Edmonds, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

380515-1205 Issued in UT

Practice address

1055 N 500 W Ste 112
Provo, UT 84604-3305

Phone

(801) 812-4624

Fax

(801) 812-4699

NPI assigned

Sep 21, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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

Diagnostic Radiology

Education

Uniformed Services Uhs Fe Hebert School of Med, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Revere Health PCGroup PAC ID 7517868508, 407 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mountain View Hospital Hospital, Payson, UT, CCN 460013
• Central Valley Medical Center - Cah Hospital, Nephi, UT, CCN 461304
• Timpanogos Regional Hospital Hospital, Orem, UT, CCN 460052
• Holy Cross Hospital-Jordan Valley Hospital, West Jordan, UT, CCN 460051

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Revere Health PC

  dba Revere Health

  • Multi-Specialty Clinic/Center
  • Provo, UT
  • NPI 1093764805
  Medicare reassignment Care Compare group NPD
• Revere Health PC

  dba Revere Health

  • Multi-Specialty Clinic/Center
  • Spanish Fork, UT
  • NPI 1851142285
  NPD
• Blue Mountain Hospital

  • Critical Access Hospital Clinic/Center
  • Blanding, UT
  • NPI 1558513812
  NPD (past)
• Regents of the Univ of Ca

  • Surgery Physician
  • Sacramento, CA
  • NPI 1427041698
  NPD (past)
• Sutter Regional Medical Foundation

  • Family Medicine Physician
  • Fairfield, CA
  • NPI 1558388504
  NPD (past)
• Sutter Valley Hospitals

  dba Sutter Davis Hospital

  • General Acute Care Hospital
  • Davis, CA
  • NPI 1770532608
  NPD (past)
• Sutter Valley Hospitals

  • General Acute Care Hospital
  • Sacramento, CA
  • NPI 1811946734
  NPD (past)

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
• Central Valley Medical Center

  • Critical Access Hospital
  • Nephi, UT
  • NPI 1881658110
  Care Compare affiliation
• Central Valley Medical Center

  dba Nephi Medical Clinic

  • Family Medicine Physician
  • Nephi, UT
  • NPI 1992724975

  Hospital

  Care Compare affiliation
• Mountain View Hospital, Inc.

  dba Mountain View Hospital

  • General Acute Care Hospital
  • Payson, UT
  • NPI 1487607669
  Care Compare affiliation
• Timpanogos Regional Medical Services, Inc.

  dba Timpanogos Regional Hospital

  • General Acute Care Hospital
  • Orem, UT
  • NPI 1497702195
  Care Compare affiliation

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

{
    "created_epoch": "1190332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742428800000",
    "number": "1124214374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 N 500 W",
            "address_2": "ATTN CREDENTIALING",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "84604",
            "telephone_number": "801-354-8225",
            "fax_number": "801-418-0941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 N 500 W STE 112",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043305",
            "telephone_number": "801-812-4624",
            "fax_number": "801-812-4699"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3000 N Triumph Blvd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Lehi",
            "state": "UT",
            "postal_code": "840434999",
            "country_code": "US",
            "telephone_number": "385-345-3155",
            "fax_number": "385-345-3163",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "555 W State Road 164",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "UT",
            "postal_code": "846535732",
            "country_code": "US",
            "telephone_number": "801-812-4624",
            "fax_number": "801-812-4699",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2825 E Mall Dr",
            "address_purpose": "LOCATION",
            "city": "St George",
            "state": "UT",
            "postal_code": "847901954",
            "country_code": "US",
            "telephone_number": "435-986-2238",
            "fax_number": "435-986-2237",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1175 E 50 S Ste 141",
            "address_purpose": "LOCATION",
            "city": "American Fork",
            "state": "UT",
            "postal_code": "840032845",
            "country_code": "US",
            "telephone_number": "801-492-5996",
            "fax_number": "801-492-5993",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EDMONDS",
        "first_name": "LANCE",
        "middle_name": "DUSTIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-21",
        "last_updated": "2025-03-20",
        "certification_date": "2025-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "A108694",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "UT",
            "license": "380515-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Edge Medical Services
• Liam Edgington
• Shawn C Edgington, PH.D.
• Edison Stanford Hearing Aid Center
• Mary Edman, LPN
• Rita Edmonds, LCSW
• David O. Edmunds
• Frank Middleton Edmunds, O.D.
• Ryan K Edmunds, DDS
• Haley Ann Edone

• Diagnostic Radiology Physician in Provo, UT
• Providers in Provo, UT by specialty
• Diagnostic Radiology Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2025; 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.