NPIMap

Individual provider Active NPI

Frederick L Gottlieb, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Salt Lake City, UT
National Provider Identifier
1174532931
Registry record updated Nov 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
177082-1205 Issued in UT
Practice address
University of Utah
50
Salt Lake City, UT 84132-0100
Phone
(801) 581-2628
NPI assigned
Aug 7, 2006
Last updated
Nov 2, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 2, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 177082-1205 UT Primary

Addresses

Primary practice location

University of Utah
50
Salt Lake City, UT 84132-0100

Mailing address

University of Utah Adult Services
PO Box 413033
Salt Lake City, UT 84141-3033
Phone (801) 213-3900

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address fgottlieb148429@direct.med.utah.edu Direct UNIVERSITY OF UTAH

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
I20051026001229 UT Practitioner - Internal Medicine 9335053263 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
West Virginia University School of Medicine, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Utah Adult ServicesGroup PAC ID 0941525273, 1,758 clinicians

Practice addresses (Care Compare)

50 N Medical Dr
Salt Lake City, UT 84132-0100
Phone (801) 581-7719

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
177082-1205UTMDGeriatric Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Adult Services Current Accepting new patients
University of Utah Adult Services CurrentSince Jul 1, 2015 Accepting new patients
Physician Group of Utah Inc CurrentSince Jul 21, 2008 Accepting new patients
University of Utah Adult Services CurrentSince Jul 1, 2015 Accepting new patients
Wasatch Geriatrics PC Geriatric Medicine Past Accepting new patients

Locations

82 S 1100 E
Ste 103
Salt Lake Cty, UT 84102
Phone (801) 505-5370

24 S 1100 E
Ste 209
Slc, UT 84102
Phone (801) 350-4602

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

2530 W 4700 S
Ste B8
Taylorsville, UT 84129
Phone (801) 967-5866

3580 W 90th S
West Jordan, UT 84088
Phone (801) 263-0810

3584 W 9000 S
Ste 300
West Jordan, UT 84088
Phone (801) 233-8233

Interoperability endpoints

  • Direct secure messaging: fgottlieb148429@direct.med.utah.edu
  • Direct secure messaging: frederick.gottlieb.1@13794.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1154908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635811200000",
    "number": "1174532931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "UNIVERSITY OF UTAH ADULT SERVICES",
            "address_2": "PO BOX 413033",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841413033",
            "telephone_number": "801-213-3900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "UNIVERSITY OF UTAH",
            "address_2": "50",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841320100",
            "telephone_number": "801-581-2628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOTTLIEB",
        "first_name": "FREDERICK",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-07",
        "last_updated": "2021-11-02",
        "certification_date": "2021-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "UT",
            "license": "177082-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "fgottlieb148429@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.