NPIMap

Organization Active NPI

Tellica Imaging, LLC

  • Physiological Laboratory
  • Ogden, UT
National Provider Identifier
1144802802
Registry record updated Mar 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physiological LaboratoryTaxonomy code 293D00000X
Legal business name
TELLICA IMAGING, LLC
Practice address
1028 Chambers St
Ogden, UT 84403-5181
Phone
(801) 442-5737
NPI assigned
Apr 22, 2021
Organization subpart
Yes
Parent organization
INTERMOUNTAIN HEALTHCAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 22, 2024

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

Authorized official

Name
Brad Isaacson, PHD
Title
President
Phone
(801) 442-5737

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X
Physiological Laboratory 293D00000X Primary

Addresses

Primary practice location

1028 Chambers St
Ogden, UT 84403-5181

Mailing address

36 S State St
Salt Lake City, UT 84111-1401

Other practice location 1

194 W 13490 S
Ste 104
Draper, UT 84020
Phone (385) 297-5510

Other practice location 2

110 N Main St Ste 200N
Bountiful, UT 84010-6134
Phone (385) 297-5520

Other practice location 3

2645 E Parleys Way Ste 200
Salt Lake City, UT 84109-1636
Phone (385) 197-5530

Other practice location 4

256 E University Pkwy
Orem, UT 84058-7601
Phone (801) 357-3225

Other practice location 5

692 East Market Place Drive
Spanish Fork, UT 84660
Phone (610) 772-7252

Other practice location 6

4587 S 4000 W
West Valley, UT 84120-6317
Phone (012) 974-2908

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT7 enrollments

Enrollment records 7

Enrollment IDStateProvider typePAC IDDetails
O20220418000658 UT Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 3577950765 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: West Valley, UT
O20220418001024 UT Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 3577950765 Practice locations: South Ogden, UT
O20220516000636 UT Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 3577950765 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Orem, UT
O20230405001699 UT Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 3577950765 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Draper, UT
O20230508000797 UT Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 3577950765 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bountiful, UT
O20230614003649 UT Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 3577950765 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Salt Lake City, UT
O20250228000987 UT Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 3577950765 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Spanish Fork, UT

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Tellica Imaging LLC10 organizations share this tax ID, including this one
Part of
Duchesne Valley Clinic

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

8505 W Overland Rd
Boise, ID 83709
Phone (208) 417-5100

110 N Main St
Bountiful, UT 84010
Phone (801) 442-5737

194 W 13490 S
Ste 104
Draper, UT 84020
Phone (385) 297-5510

256 E University Pkwy
Orem, UT 84058
Phone (801) 357-3225

2645 E Parleys Way
Ste 200
Salt Lake City, UT 84109
Phone (385) 297-5510

Practitioners & affiliated clinicians

Practitioners 131

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

View all 131

NPI Registry JSON

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

{
    "created_epoch": "1619049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711065600000",
    "number": "1144802802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36 S STATE ST",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841111401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1028 CHAMBERS ST",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844035181",
            "telephone_number": "801-442-5737"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "194 W 13490 S",
            "address_2": "STE 104",
            "address_purpose": "LOCATION",
            "city": "Draper",
            "state": "UT",
            "postal_code": "84020",
            "country_code": "US",
            "telephone_number": "385-297-5510",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "110 N Main St Ste 200N",
            "address_purpose": "LOCATION",
            "city": "Bountiful",
            "state": "UT",
            "postal_code": "840106134",
            "country_code": "US",
            "telephone_number": "385-297-5520",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2645 E Parleys Way Ste 200",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841091636",
            "country_code": "US",
            "telephone_number": "385-197-5530",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "256 E University Pkwy",
            "address_purpose": "LOCATION",
            "city": "Orem",
            "state": "UT",
            "postal_code": "840587601",
            "country_code": "US",
            "telephone_number": "801-357-3225",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "692 East Market Place Drive",
            "address_purpose": "LOCATION",
            "city": "Spanish Fork",
            "state": "UT",
            "postal_code": "84660",
            "country_code": "US",
            "telephone_number": "610-772-7252",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4587 S 4000 W",
            "address_purpose": "LOCATION",
            "city": "West Valley",
            "state": "UT",
            "postal_code": "841206317",
            "country_code": "US",
            "telephone_number": "012-974-2908",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TELLICA IMAGING, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INTERMOUNTAIN HEALTHCARE",
        "enumeration_date": "2021-04-22",
        "last_updated": "2024-03-22",
        "certification_date": "2024-03-20",
        "status": "A",
        "authorized_official_last_name": "ISAACSON",
        "authorized_official_first_name": "BRAD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "801-442-5737",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ogden, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.