Kevin Clifford Shosted, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

7385204-9934 Issued in UT

Practice address

2828 W 4700 S
Suite D
Salt Lake City, UT 84118-2154

Phone

(801) 281-3937

Fax

(801) 281-1430

NPI assigned

Jun 23, 2009

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Pacific University - College of Optometry, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Family Focused Eyecare LLCGroup PAC ID 3577609031, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• UT PPO D-SNP
• UT PPO

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.

• Family Focused Eyecare LLC

  • Optometrist
  • Herriman, UT
  • NPI 1558593145
  Medicare reassignment Care Compare group NPD
• Terry M Hansen OD LLC

  • Optometrist
  • Salt Lake City, UT
  • NPI 1104150770
  NPD (past)

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

{
    "created_epoch": "1245715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1336089600000",
    "number": "1164650685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2828 W 4700 S",
            "address_2": "SUITE D",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841182154",
            "telephone_number": "801-281-3937",
            "fax_number": "801-281-1430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2828 W 4700 S",
            "address_2": "SUITE D",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841182154",
            "telephone_number": "801-281-3937",
            "fax_number": "801-281-1430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOSTED",
        "first_name": "KEVIN",
        "middle_name": "CLIFFORD",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-06-23",
        "last_updated": "2012-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "UT",
            "license": "7385204-9934",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shopko Stores Operating Co. LLC
• Shopko Stores Operating Co. LLC
• Scott Short, MD
• Steven Short
• James Shortridge, DO
• Kianna Shotorbani, MD
• Loay Shoubash
• Benjamin T Showalter, MD
• Mallory Showalter, MD
• Allison Shrack

• Optometrist in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Optometrist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.