NPIMap

Individual provider Active NPI

Dana Boucek

  • Pediatric Cardiology Physician
  • Salt Lake City, UT
National Provider Identifier
1154612117
Registry record updated Oct 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
License
MD460722 Issued in PA
Practice address
100 North Mario Capecchi Dr.
Primary Children'S
Salt Lake City, UT 84113
Phone
(801) 662-5700
NPI assigned
Apr 26, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 28, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Cardiology Physician 2080P0202X MD460722 PA Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

100 North Mario Capecchi Dr.
Primary Children'S
Salt Lake City, UT 84113

Mailing address

3601 Market St Unit 1713
Philadelphia, PA 19104-5914
Phone (303) 746-7692

Other practice location 1

3401 Civic Center Blvd
Division of Pediatric Cardiology
Phildelphia, PA 19104
Phone (215) 590-3274

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dboucek37506@direct.med.utah.edu Direct University of Utah

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190320000741 UT Practitioner - Pediatric MedicinePractitioner - Cardiovascular Disease (Cardiology) 2961634977 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pediatric MedicineAlso: Cardiovascular Disease (Cardiology)
Education
University of Colorado School of Medicine, Denver, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

100 N Mario Capecchi Dr
Salt Lake City, UT 84113-1103
Phone (801) 587-7109

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD460722PAMDPediatric Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Pediatric Services CurrentSince Dec 11, 2018 Accepting new patients
University of Utah Adult Services CurrentSince Dec 11, 2018 Accepting new patients
University of Utah Adult Services CurrentSince Dec 11, 2018 Accepting new patients
University of Utah Pediatric Services Current Accepting new patients
University of Utah Pediatric Acuity Care CurrentSince Dec 11, 2018 Accepting new patients
University of Utah Adult Services Current Accepting new patients
Ihc Health Services Inc Past Accepting new patients
University of Utah Pediatric Acuity Care Past Accepting new patients
University of Utah Pediatric Services Past Accepting new patients
Ihc Health Services Inc Past Accepting new patients
Bronson Lakeview Hospital Past Accepting new patients

Locations

81 N Mario Capecchi Dr
Slc, UT 84113
Phone (801) 662-5700

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

100 N Mario Capecchi Dr
Slc, UT 84113
Phone (801) 587-7109

Interoperability endpoints

  • Direct secure messaging: dboucek37506@direct.med.utah.edu

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1303776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635379200000",
    "number": "1154612117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3601 MARKET ST UNIT 1713",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191045914",
            "telephone_number": "303-746-7692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 NORTH MARIO CAPECCHI DR.",
            "address_2": "PRIMARY CHILDREN'S",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "84113",
            "telephone_number": "801-662-5700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3401 Civic Center Blvd",
            "address_2": "Division of Pediatric Cardiology",
            "address_purpose": "LOCATION",
            "city": "Phildelphia",
            "state": "PA",
            "postal_code": "19104",
            "country_code": "US",
            "telephone_number": "215-590-3274",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOUCEK",
        "first_name": "DANA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-04-26",
        "last_updated": "2021-10-28",
        "certification_date": "2021-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "PA",
            "license": "MD460722",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dboucek37506@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.