Salt Lake Retina, LLC

Primary specialty

Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X

Legal business name

SALT LAKE RETINA, LLC

Doing business as

Salt Lake Retina

Practice address

3855 W 7800 S
Suite 100
West Jordan, UT 84088-5560

Phone

(801) 260-0034

Fax

(801) 260-0035

NPI assigned

Sep 19, 2014

Last updated

Apr 10, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Douglas S Mehr, MDNPI 1720070899

Title

President

Phone

(801) 260-0034

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Salt Lake Retina Doing business as

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

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

CLIA laboratory certificates

Locations

Interoperability endpoints

• Direct secure messaging: adavis@saltlakeretina.intellechartdirect.net
• Direct secure messaging: cgee@saltlakeretina.intellechartdirect.net
• Direct secure messaging: dmehr@saltlakeretina.intellechartdirect.net

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Douglas Stewart Mehr, M.D.

  • Retina Specialist (Ophthalmology) Physician
  • West Jordan, UT
  • NPI 1720070899
  Medicare reassignment Care Compare group Authorized official
• Andrew Davis, M.D.

  • Retina Specialist (Ophthalmology) Physician
  • West Jordan, UT
  • NPI 1922012582
  Medicare reassignment Care Compare group
• Christopher Jordon Gee, M.D.

  • Retina Specialist (Ophthalmology) Physician
  • West Jordan, UT
  • NPI 1831372499
  Medicare reassignment Care Compare group
• Rebekah Gensure, M.D., PH.D.

  • Retina Specialist (Ophthalmology) Physician
  • Salt Lake City, UT
  • NPI 1225490444
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1411084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681084800000",
    "number": "1144622234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3855 W 7800 S",
            "address_2": "SUITE 100",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840885560",
            "telephone_number": "801-260-0034",
            "fax_number": "801-260-0035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3855 W 7800 S",
            "address_2": "SUITE 100",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840885560",
            "telephone_number": "801-260-0034",
            "fax_number": "801-260-0035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SALT LAKE RETINA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-19",
        "last_updated": "2023-04-10",
        "certification_date": "2022-09-08",
        "status": "A",
        "authorized_official_last_name": "MEHR",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "801-260-0034",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "UT",
            "license": "5934492-1205",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology, Retina Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1508052234",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Salt Lake Retina",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Salt Lake Retina",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Anthony Gage Safford, LMT
• Kevin Michael Sagers, D.O.
• Kevin Michael Salmon, CMHC-INTERN
• Salson Clinics LLC
• Salt City Anesthesia LLC
• Salt Lake Valley Surgical LLC
• Sam's Club Optical (Sam's Club Optical 30-4730)
• Faridatou Samarou, PHARMD
• Indra Samayoa
• Curtis Duane Sampson, D.D.S.

• Retina Specialist (Ophthalmology) Physician in West Jordan, UT
• Providers in West Jordan, UT by specialty
• Retina Specialist (Ophthalmology) Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2023; 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.