Individual provider Active NPI

John S Vitkus, PHD

  • Psychologist
  • Salt Lake City, UT
National Provider Identifier
1164458972
Registry record updated Jan 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
11351485-2501 Issued in UT
Practice address
324 E 10TH Ave Ste 178
Salt Lake City, UT 84103-2885
Phone
(801) 408-8500
Fax
(801) 408-8510
NPI assigned
Jun 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 11351485-2501 UT Primary
Psychologist 103T00000X 5437 OH

Addresses

Primary practice location

324 E 10TH Ave Ste 178
Salt Lake City, UT 84103-2885

Mailing address

PO Box 27128
Salt Lake City, UT 84127-0128

Other identifiers 1

IdentifierTypeStateIssuer
2141435MedicaidOH

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191126000989 UT Practitioner - Clinical Psychologist 2365441680 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Practice addresses (Care Compare)

324 E 10TH Ave
Suite 178
Salt Lake City, UT 84103-2885
Phone (801) 408-8502

700 S Hwy 99
Suite 3
Fillmore, UT 84631-5137
Phone (801) 357-4600

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11351485-2501UTMDPsychologist
5437OHMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services Inc CurrentSince Oct 1, 2019 Accepting new patients
Ihc Health Services Inc Current Accepting new patients
Ihc Health Services, Inc. CurrentSince Oct 1, 2019 Accepting new patients

Locations

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

390 N Main St
N Salt Lake, UT 84010
Phone (801) 294-1000

324 Tenth Ave
Ste 178
Slc, UT 84103
Phone (801) 321-2500

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736726400000",
    "number": "1164458972",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "324 E 10TH AVE STE 178",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841032885",
            "telephone_number": "801-408-8500",
            "fax_number": "801-408-8510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VITKUS",
        "first_name": "JOHN",
        "middle_name": "S",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-23",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "UT",
            "license": "11351485-2501",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OH",
            "license": "5437",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2141435",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.