NPIMap

Individual provider Active NPI

Mark B. Bromberg, M.D.,PH.D.

  • Neurology Physician
  • Salt Lake City, UT
National Provider Identifier
1164517009
Registry record updated Nov 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
274745-1205 Issued in UT
Practice address
30 N 1900 E Som # 3R210
Salt Lake City, UT 84132-0001
Phone
(801) 585-5885
NPI assigned
Oct 4, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 11, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 8340A WY
Neurology Physician 2084N0400X 274745-1205 UT Primary

Addresses

Primary practice location

30 N 1900 E Som # 3R210
Salt Lake City, UT 84132-0001

Mailing address

2782 St Marys Way
Salt Lake City, UT 84108-2040
Phone (801) 585-5885

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mbromberg49409@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
I20041027000360 UT Practitioner - Neurology 5890757421 Reassigns benefits to 1 organization
I20101119000920 WY Practitioner - Neurology 5890757421 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
University of Michigan Medical School, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University of Utah Adult ServicesGroup PAC ID 0941525273, 1,758 clinicians
Teton County Hospital DistrictGroup PAC ID 4880582295, 107 clinicians

Practice addresses (Care Compare)

50 N Medical Dr
Salt Lake City, UT 84132-0100
Phone (801) 585-3229

625 E Broadway Ave
Jackson, WY 83001-8642
Phone (307) 733-3636

Hospital & facility affiliations

  • University of Utah Hospital and Clinics Hospital, Salt Lake City, UT, CCN 460009
  • St Johns Medical Center Hospital, Jackson, WY, CCN 530015

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

Merit-based Incentive Payment System (MIPS)

Final score
81.82 of 100Reported as group
Quality
67.1
Promoting interoperability
98
Improvement activities
40
Cost
73.98

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Teton County Hospital District CurrentSince Oct 3, 2010 Accepting new patients
University of Utah Adult Services CurrentSince Feb 1, 2015 Accepting new patients
University of Utah Adult Services Current Accepting new patients
University of Utah Adult Services CurrentSince Feb 1, 2015 Accepting new patients
University Health Care Past Accepting new patients
Teton County Hospital District Past Accepting new patients
Bronson Lakeview Hospital Past Accepting new patients

Locations

175 N Medical Dr
Slc, UT 84112
Phone (801) 581-6908

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

Interoperability endpoints

  • Direct secure messaging: mbromberg49409@direct.med.utah.edu

Organizations & group practices 7

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": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636588800000",
    "number": "1164517009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2782 ST MARYS WAY",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841082040",
            "telephone_number": "801-585-5885",
            "fax_number": "801-585-2054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 N 1900 E SOM # 3R210",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841320001",
            "telephone_number": "801-585-5885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROMBERG",
        "first_name": "MARK",
        "middle_name": "B.",
        "credential": "M.D.,PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2021-11-11",
        "certification_date": "2021-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "WY",
            "license": "8340A",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "UT",
            "license": "274745-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mbromberg49409@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.