Organization Active NPI

Rubicon Health and Wellness LLC

  • General Practice Physician
  • Layton, UT
National Provider Identifier
1144052218
Registry record updated Oct 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
RUBICON HEALTH AND WELLNESS LLC
Practice address
1536 Woodland Park Dr Ste 210
Layton, UT 84041-5620
Phone
(385) 393-7486
NPI assigned
Aug 16, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2024

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

Authorized official

Name
Ian Hess
Title
Manager
Phone
(385) 393-7486

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

1536 Woodland Park Dr Ste 210
Layton, UT 84041-5620

Mailing address

1536 Woodland Park Dr Ste 210
Layton, UT 84041-5620
Phone (385) 393-7486

Other identifiers 1

IdentifierTypeStateIssuer
5642777-4405OtherUTAPRN, FNP LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241030001524 UT Part B Supplier - Clinic/Group Practice 8921531856 Receives reassigned benefits from 3 practitioners
Practice locations: Layton, UT

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
46D2319826Rubicon Health and Wellness1536 Woodland Park Drive, Ste 210, Layton, UT 84041Provider-performed microscopyMar 6, 2027

National Provider Directory

National Provider Directory

Locations

1536 Woodland Park Dr
Ste 210
Layton, UT 84041
Phone (385) 393-7486

1536 Woodland Park Dr
Layton, UT 84041
Phone (801) 525-5254

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1723766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728000000000",
    "number": "1144052218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1536 WOODLAND PARK DR STE 210",
            "city": "LAYTON",
            "state": "UT",
            "postal_code": "840415620",
            "telephone_number": "385-393-7486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1536 WOODLAND PARK DR STE 210",
            "city": "LAYTON",
            "state": "UT",
            "postal_code": "840415620",
            "telephone_number": "385-393-7486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUBICON HEALTH AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-16",
        "last_updated": "2024-10-04",
        "certification_date": "2024-10-04",
        "status": "A",
        "authorized_official_last_name": "HESS",
        "authorized_official_first_name": "IAN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "385-393-7486"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APRN, FNP LICENSE",
            "identifier": "5642777-4405",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Layton, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.