NPIMap

Individual provider Active NPI

Kevin Maxwell, M.D.

  • Vascular & Interventional Radiology Physician
  • Salt Lake City, UT
National Provider Identifier
1184044190
Registry record updated Oct 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
11785838-1205 Issued in UT
Practice address
1200 E 3900 S
Salt Lake City, UT 84124-1300
Phone
(801) 268-7111
NPI assigned
Apr 17, 2014
Last updated
Oct 21, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology Physician 2085R0204X 11785838-1205 UT Primary

Addresses

Primary practice location

1200 E 3900 S
Salt Lake City, UT 84124-1300

Mailing address

1433 N 1075 W Ste 104
Farmington, UT 84025-2746
Phone (801) 298-1300

Other practice location 1

1200 E 3900 S
Salt Lake City, UT 84124-1300
Phone (801) 268-7111

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
I20200618000156 UT Practitioner - Diagnostic Radiology 9638476609 Reassigns benefits to 8 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Granger Medical Clinic PCGroup PAC ID 3476465691, 192 clinicians
Wasatch Vascular Center LLCGroup PAC ID 1951726967, 6 clinicians
Utah Imaging Associates IncGroup PAC ID 1355394537, 45 clinicians

Practice addresses (Care Compare)

2965 W 3500
West Valley City, UT 84119-3602
Phone (801) 965-3600

3702 S State St
Suite 103
South Salt Lake, UT 84115-5096
Phone (801) 281-0027

630 Medical Dr
Bountiful, UT 84010-4908
Phone (801) 299-2220

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.06 of 100Reported as group
Quality
100
Improvement activities
40
Cost
76.86

Merit-based Incentive Payment System (MIPS)

Final score
54.26 of 100Reported as group
Quality
56.16
Promoting interoperability
0
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11785838-1205UTMDVascular & Interventional Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Granger Medical Clinic PC Pediatrics CurrentSince Aug 1, 2025 Accepting new patients
Granger Medical Clinic PC Pediatrics Current Accepting new patients
Granger Medical Specialists LLC CurrentSince Aug 1, 2025 Accepting new patients
Tanner Memorial Clinic Pediatrics Current Accepting new patients
Granger Medical Specialists, LLC CurrentSince Aug 1, 2025 Accepting new patients
Green River Radiology, P.C. CurrentSince Jan 1, 2022 Accepting new patients
Tanner Memorial Clinic CurrentSince Nov 13, 2024 Accepting new patients
Perspective Counseling Services LLC CurrentSince Dec 1, 2025 Accepting new patients
Wasatch Vascular Center LLC Vascular & Interventional Radiology CurrentSince Jul 1, 2020 Accepting new patients
Tanner Memorial Clinic CurrentSince Nov 13, 2024 Accepting new patients
Wasatch Imaging LLC CurrentSince Sep 15, 2024 Accepting new patients
Tooele Valley Imaging, LLC CurrentSince Oct 1, 2020 Accepting new patients
Granger Medical Clinic PC CurrentSince Aug 1, 2025 Accepting new patients
Wasatch Vascular Center ASC LLC PastSince Jul 1, 2020 Accepting new patients

Locations

1433 N 1075 W
Ste 104
Farmington, UT 84025
Phone (801) 281-0869

425 S 100 W
Layton, UT 84041
Phone (801) 525-8726

12391 S 4000 W
Riverton, UT 84096
Phone (801) 302-1700

12842 S 3600 W
Ste 100
Riverton, UT 84065
Phone (385) 253-4586

9844 S 1300 E
Ste 175
Sandy, UT 84094
Phone (801) 576-1290

3702 S State St
Ste 103
South Salt Lake, UT 84115
Phone (801) 281-0027

3702 S State St
Ste 111
South Salt Lake, UT 84115
Phone (801) 281-0027

995 W Levoy Dr
Taylorsville, UT 84123

2356 N 400 E
Ste 103
Tooele, UT 84074
Phone (435) 882-1674

2965 W 3500 S
West Valley City, UT 84119
Phone (801) 965-3505

Interoperability endpoints

  • Direct secure messaging: kevin.maxwell.p121@direct.aac.nextgenshare.com
  • Direct secure messaging: kevin.maxwell.p122@direct.aac.nextgenshare.com

Organizations & group practices 15

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.

View all 15

Hospital & facility affiliations 5

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": "1397692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603238400000",
    "number": "1184044190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1433 N 1075 W STE 104",
            "city": "FARMINGTON",
            "state": "UT",
            "postal_code": "840252746",
            "telephone_number": "801-298-1300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 E 3900 S",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841241300",
            "telephone_number": "801-268-7111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1200 E 3900 S",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841241300",
            "country_code": "US",
            "telephone_number": "801-268-7111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAXWELL",
        "first_name": "KEVIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-17",
        "last_updated": "2020-10-21",
        "certification_date": "2020-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "UT",
            "license": "11785838-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.