Active NPI
Samuel Jones Llavina, MD
- Psychiatry Physician
- Draper, UT
National Provider Identifier
1154180404
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 14245432-1205
- Practice address
- 12222 S 1000 E Ste 3
Draper, UT 84020-3203 - Phone
- (801) 987-3592
- NPI assigned
- Mar 18, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 14245432-1205 | UT | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Behavior Technician | 106S00000X |
Addresses
Primary practice location
12222 S 1000 E Ste 3
Draper, UT 84020-3203
Mailing address
501 S Chipeta Way
Salt Lake City, UT 84108-1222
Phone (801) 585-0895
Other practice location 1
501 S Chipeta Way
Salt Lake City, UT 84108-1222
Phone (801) 585-0895
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251015004078 | UT | Order and Referring Only - Psychiatry | 1153818802 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1710720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1759104000000",
"number": "1154180404",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "501 S CHIPETA WAY",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841081222",
"telephone_number": "801-585-0895"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12222 S 1000 E STE 3",
"city": "DRAPER",
"state": "UT",
"postal_code": "840203203",
"telephone_number": "801-987-3592"
}
],
"practiceLocations": [
{
"address_1": "501 S Chipeta Way",
"address_purpose": "LOCATION",
"city": "Salt Lake City",
"state": "UT",
"postal_code": "841081222",
"country_code": "US",
"telephone_number": "801-585-0895",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LLAVINA",
"first_name": "SAMUEL",
"middle_name": "JONES",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-03-18",
"last_updated": "2025-09-29",
"certification_date": "2025-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "UT",
"license": "14245432-1205",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Draper, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.