Active NPI
Trent C. Holmberg, M.D.
- Psychiatry Physician
- Draper, UT
National Provider Identifier
1174546337
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 376105-1205
- Practice address
- 12481 S Fort St Ste 275
Draper, UT 84020-2106 - Phone
- (801) 432-2077
- Fax
- (801) 432-2079
- NPI assigned
- Jul 26, 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 376105-1205 | UT | Primary |
| Forensic Psychiatry Physician | 2084F0202X | 3761051205 | UT |
Addresses
Primary practice location
12481 S Fort St Ste 275
Draper, UT 84020-2106
Mailing address
12481 S Fort St Ste 275
Draper, UT 84020-2106
Phone (801) 432-2077
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 1, 2016 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3761051205 | UT | MD | Forensic Psychiatry Physician |
| 376105-1205 | UT | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ihc Health Services Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Midvale, UT
- NPI 1891810867
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1737936000000",
"number": "1174546337",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12481 S FORT ST STE 275",
"city": "DRAPER",
"state": "UT",
"postal_code": "840202106",
"telephone_number": "801-432-2077",
"fax_number": "801-432-2079"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12481 S FORT ST STE 275",
"city": "DRAPER",
"state": "UT",
"postal_code": "840202106",
"telephone_number": "801-432-2077",
"fax_number": "801-432-2079"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLMBERG",
"first_name": "TRENT",
"middle_name": "C.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-26",
"last_updated": "2025-01-27",
"certification_date": "2025-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "UT",
"license": "376105-1205",
"primary": true
},
{
"code": "2084F0202X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Forensic Psychiatry",
"state": "UT",
"license": "3761051205",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Draper, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2025; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.