NPIMap

Individual provider Active NPI

Russell Wayne Rhoades, DO

  • Internal Medicine Physician
  • Provo, UT
National Provider Identifier
1164436507
Registry record updated May 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
5928040-1204 Issued in UT
Practice address
1034 N 500 W
Provo, UT 84604-3380
Phone
(801) 357-7291
NPI assigned
Jul 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 10, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 5928040-1204 UT Primary

Addresses

Primary practice location

1034 N 500 W
Provo, UT 84604-3380

Mailing address

PO Box 27128
Salt Lake City, UT 84127-0128
Phone (801) 357-7291

Other practice location 1

1175 E 50 S Ste 241
American Fork, UT 84003-2849
Phone (801) 492-5999

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Medreview@reverehealth.com Revere Health PC

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
I20051103000279 UT Practitioner - Osteopathic Manipulative MedicinePractitioner - Internal Medicine 6507884004 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Osteopathic Manipulative MedicineAlso: Internal Medicine
Education
Kansas City University of Physicians and Surgeons, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Revere Health PCGroup PAC ID 7517868508, 407 clinicians

Practice addresses (Care Compare)

1055 N 500
Provo, UT 84604-3305
Phone (801) 374-2362

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services, Inc. CurrentSince Jul 1, 2005 Accepting new patients
Ihc Health Services Inc Current Accepting new patients
Revere Health PC CurrentSince Apr 18, 2022 Accepting new patients
Ihc Health Services Inc CurrentSince Jul 1, 2005 Accepting new patients
Revere Health PC CurrentSince Apr 18, 2022 Accepting new patients

Locations

170 N 1100 E
American Fork, UT 84003
Phone (801) 714-6570

1175 E 50 S
Ste 241
American Fork, UT 84003
Phone (801) 429-8095

700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555

1034 N 500 W
Provo, UT 84604
Phone (801) 362-4119

1055 N 500 W
Ste 212
Provo, UT 84604
Phone (801) 374-2362

1055 N 300 W
Ste 302
Provo, UT 84604
Phone (801) 357-2534

1055 N 500 W
Provo, UT 84604
Phone (801) 429-8000

1380 E Medical Center Dr
#P
St George, UT 84790
Phone (435) 251-2355

Networks

  • UT PPO
  • UT PPO D-SNP

Interoperability endpoints

  • Direct secure messaging: russellrhoades@cuccu.allscriptsdirect.net

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 7

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": "1154131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652140800000",
    "number": "1164436507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27128",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841270128",
            "telephone_number": "801-357-7291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1034 N 500 W",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043380",
            "telephone_number": "801-357-7291"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1175 E 50 S Ste 241",
            "address_purpose": "LOCATION",
            "city": "American Fork",
            "state": "UT",
            "postal_code": "840032849",
            "country_code": "US",
            "telephone_number": "801-492-5999",
            "fax_number": "801-418-0897",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RHOADES",
        "first_name": "RUSSELL",
        "middle_name": "WAYNE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-29",
        "last_updated": "2022-05-10",
        "certification_date": "2022-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "UT",
            "license": "5928040-1204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Medreview@reverehealth.com",
            "affiliation": "Y",
            "affiliationName": "Revere Health PC",
            "address_1": "1055 N 500 W",
            "city": "Provo",
            "state": "UT",
            "country_code": "US",
            "postal_code": "846043305",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Provo, UT

Sources for this page

Verify at the official NPI Registry.