NPIMap

Organization Active NPI

Mountainstar Behavioral Health LLC

  • Neurology Physician
  • Bountiful, UT
National Provider Identifier
1174868525
Registry record updated Aug 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
MOUNTAINSTAR BEHAVIORAL HEALTH LLC
Practice address
630 Medical Dr
Bountiful, UT 84010-4908
Phone
(801) 299-2186
Fax
(801) 299-2416
NPI assigned
Dec 11, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2023

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

Authorized official

Name
Louis Joseph
Title
VP
Phone
(615) 373-7630

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084N0400X Primary

Addresses

Primary practice location

630 Medical Dr
Bountiful, UT 84010-4908

Mailing address

2000 Health Park Dr
Brentwood, TN 37027-4525
Phone (615) 373-7406

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT, ID2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130605000270 UT Part B Supplier - Clinic/Group Practice 1052558186 Receives reassigned benefits from 17 practitioners
Practice locations: Bountiful, UT; Ogden, UT; Payson, UT; Salt Lake City, UT
O20260109001204 ID Part B Supplier - Clinic/Group Practice 1052558186 Receives reassigned benefits from 1 practitioner
Practice locations: Idaho Falls, ID

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

620 Medical Dr
Ste 175A
Bountiful, UT 84010
Phone (801) 299-3731

5495 S 500 E
Ste 350
Ogden, UT 84405
Phone (801) 475-3100

1000 E 100 N
Payson, UT 84651
Phone (801) 465-7000

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1355184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693267200000",
    "number": "1174868525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 HEALTH PARK DR",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370274525",
            "telephone_number": "615-373-7406",
            "fax_number": "866-346-1426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 MEDICAL DR",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840104908",
            "telephone_number": "801-299-2186",
            "fax_number": "801-299-2416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAINSTAR BEHAVIORAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-11",
        "last_updated": "2023-08-29",
        "certification_date": "2023-08-29",
        "status": "A",
        "authorized_official_last_name": "JOSEPH",
        "authorized_official_first_name": "LOUIS",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "615-373-7630"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bountiful, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.