NPIMap

Individual provider Active NPI

Holden M. Wagstaff, MD

  • Emergency Medicine Physician
  • Salt Lake City, UT
National Provider Identifier
1154882215
Registry record updated Aug 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
6810542-1205 Issued in UT
Practice address
30 N 1900 E RM 1C026
Salt Lake City, UT 84132-0001
Phone
(801) 581-2272
NPI assigned
Mar 29, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 6810542-1205 UT Primary

Addresses

Primary practice location

30 N 1900 E RM 1C026
Salt Lake City, UT 84132-0001

Mailing address

30 N 1900 E RM 1C026
Salt Lake City, UT 84132-0001
Phone (801) 581-2272

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address HWAGSTAFF352175@DIRECT.MED.UTAH.EDU Direct University of Utah

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT, WY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220719002264 UT Practitioner - Emergency Medicine 0446678130 Reassigns benefits to 1 organization
I20230912000820 WY Practitioner - Emergency Medicine 0446678130 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Rochester School of Medicine and Dentistry, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Utah Adult ServicesGroup PAC ID 0941525273, shared by 7 NPIs, 1,758 clinicians

Practice addresses (Care Compare)

1200 College Dr
Rock Springs, WY 82901-5868
Phone (801) 581-3495

50 N Medical Dr
Salt Lake City, UT 84132-0100
Phone (801) 585-6387

Hospital & facility affiliations

  • University of Utah Hospital and Clinics Hospital, Salt Lake City, UT, CCN 460009
  • Holy Cross Hospital - Salt Lake Hospital, Salt Lake City, UT, CCN 460003

Merit-based Incentive Payment System (MIPS)

Final score
89.77 of 100Reported as group
Quality
91.47
Promoting interoperability
100
Improvement activities
40
Cost
74.42

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Adult Services Current Accepting new patients
University of Utah Adult Services CurrentSince Jun 15, 2022 Accepting new patients
University of Utah Adult Services Current Accepting new patients
University of Utah Adult Services Emergency Medicine CurrentSince Aug 1, 2023 Accepting new patients
University of Utah Adult Services CurrentSince Jun 15, 2022 Accepting new patients

Locations

127 S 500 E
Ste 400B
Salt Lake City, UT 84102
Phone (801) 587-6478

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

1200 College Dr
Rock Springs, WY 82901
Phone (307) 352-8352

Interoperability endpoints

  • Direct secure messaging: hwagstaff352175@direct.med.utah.edu

Organizations & group practices 5

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 4

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": "1553817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660262400000",
    "number": "1154882215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 N 1900 E RM 1C026",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841320001",
            "telephone_number": "801-581-2272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 N 1900 E RM 1C026",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841320001",
            "telephone_number": "801-581-2272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGSTAFF",
        "first_name": "HOLDEN",
        "middle_name": "M.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-29",
        "last_updated": "2022-08-12",
        "certification_date": "2022-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "UT",
            "license": "6810542-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "HWAGSTAFF352175@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.