Active NPI
Brian Gill, M.D.
- Surgery Physician
- Provo, UT
National Provider Identifier
1164528717
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 35108
- Practice address
- 3550 N. University Ave. #250
Provo, UT 84604 - Phone
- (801) 374-9625
- Fax
- (801) 374-9690
- NPI assigned
- Sep 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 7656872-1205 | UT | |
| Surgery Physician | 208600000X | 35108 | CO | Primary |
Addresses
Primary practice location
3550 N. University Ave. #250
Provo, UT 84604
Mailing address
3550 N University Ave Ste 250
Provo, UT 84604-6685
Phone (801) 374-9625
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01351089 | Medicaid | CO |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | brian.gill@direct.imail.org |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35108 | CO | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Surgone, PC | Surgery | Past | Accepting new patients |
| Rocky Mountain Cancer Centers, LLP | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Surgical Oncology Physician
- Lone Tree, CO
- NPI 1467305359
-
- Surgery Physician
- Greenwood Village, CO
- NPI 1841747128
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632700800000",
"number": "1164528717",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3550 N UNIVERSITY AVE STE 250",
"city": "PROVO",
"state": "UT",
"postal_code": "846046685",
"telephone_number": "801-374-9625",
"fax_number": "801-374-9690"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3550 N. UNIVERSITY AVE. #250",
"city": "PROVO",
"state": "UT",
"postal_code": "84604",
"telephone_number": "801-374-9625",
"fax_number": "801-374-9690"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILL",
"first_name": "BRIAN",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-14",
"last_updated": "2021-09-27",
"certification_date": "2021-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "UT",
"license": "7656872-1205",
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "CO",
"license": "35108",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01351089",
"state": "CO"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "brian.gill@direct.imail.org",
"affiliation": "N",
"address_1": "3550 N. University Ave. #250",
"city": "Provo",
"state": "UT",
"country_code": "US",
"postal_code": "84604",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Provo, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.