Active NPI
Brandon Ellis Tullis, M.D.
- Sports Medicine (Internal Medicine) Physician
- Park City, UT
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Internal Medicine) Physician
- License
- 5980963-1205
- Practice address
- 3850 Canyons Resort Drive
Park City, UT 84098-6546 - Phone
- (435) 645-4130
- NPI assigned
- Sep 16, 2013
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Internal Medicine) Physician | 207RS0010X | 5980963-1205 | UT | Primary |
Addresses
Primary practice location
3850 Canyons Resort Drive
Park City, UT 84098-6546
Mailing address
PO Box 27128
Salt Lake City, UT 84127-0128
Phone (435) 645-4130
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Hospitalist
- Education
- Oregon Health Sciences University School of Medicine, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1034 N 500
Provo, UT 84604-3380
Phone (801) 357-8879
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5980963-1205 | UT | MD | Sports Medicine (Internal Medicine) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ihc Health Services Inc | Current | Accepting new patients | |
| Ihc Health Services Inc | Current | Accepting new patients | |
| Ihc Health Services, Inc. | Current | Accepting new patients |
Locations
700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555
1034 N 500 W
Provo, UT 84604
Phone (801) 362-4119
Organizations & group practices 3
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.
-
- Multi-Specialty Clinic/Center
- Sandy, UT
- NPI 1942325154
-
dba St George Adolescent Partial Hospitalization
- Psychiatry Physician
- St George, UT
- NPI 1023843844
Hospital & facility affiliations 7
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Intermountain Health Utah Valley Hospital
- General Acute Care Hospital
- Provo, UT
- NPI 1114025491
-
dba Intermountain Health Spanish Fork Hospital
- General Acute Care Hospital
- Spanish Fork, UT
- NPI 1124661384
-
dba Intermountain Health Sevier Valley Hospital
- General Acute Care Hospital
- Richfield, UT
- NPI 1336256775
-
dba Intermountain Health Infusion Center- Spanish Fork, A Service of Utah Valley Hospital
- Infusion Therapy Clinic/Center
- Spanish Fork, UT
- NPI 1679426944
Hospital
-
dba Intermountain Health American Fork Hospital
- General Acute Care Hospital
- American Fork, UT
- NPI 1912014358
-
dba Intermountain Health Infusion Center- American Fork, A Service of Utah Valley Hospital
- Infusion Therapy Clinic/Center
- American Fork, UT
- NPI 1982557252
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1379289600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1659484800000",
"number": "1184050601",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 27128",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841270128",
"telephone_number": "435-645-4130"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3850 CANYONS RESORT DRIVE",
"city": "PARK CITY",
"state": "UT",
"postal_code": "840986546",
"telephone_number": "435-645-4130"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TULLIS",
"first_name": "BRANDON",
"middle_name": "ELLIS",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-09-16",
"last_updated": "2022-08-03",
"certification_date": "2022-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "207RS0010X",
"taxonomy_group": "",
"desc": "Internal Medicine, Sports Medicine",
"state": "UT",
"license": "5980963-1205",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Park City, UT
- Devin Tracey
- Tranquillity at Home - Caregiving Services
- Travel Health Vaccines Inc
- Tara Marie Kramlich Trebesch, ACMHC, IHP, CFA, CN
- Kayla Trobec, P.T., DPT
- Raymond Kent Turley Jr., PA-C
- Jason Andrew Turner, LCSW
- Sean Manning Udell, MD
- Teri Underwood, R.D., M.S., C.D.
- University Health Care Park City Mountain Resort Urgent Care
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2022; 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.