Daniel Edmund Banellis

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Practice address

411 Grant St
Salt Lake City, UT 84116-2725

Phone

(801) 359-8862

Fax

(801) 359-8510

NPI assigned

Jun 15, 2012

Sex

Male

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 15, 2012.

{
    "created_epoch": "1339718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339718400000",
    "number": "1194087015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 NORTH 1756 WEST, APT 56B",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "84116",
            "telephone_number": "801-359-8862",
            "fax_number": "801-359-8510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 GRANT ST",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841162725",
            "telephone_number": "801-359-8862",
            "fax_number": "801-359-8510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANELLIS",
        "first_name": "DANIEL",
        "middle_name": "EDMUND",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-06-15",
        "last_updated": "2012-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1376550566",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrew Bambrough
• Michele Bamgartner, MD
• Himabindu Bandaru, MD
• David Bandbaz
• Trisha Lynn Bandeka-Bennett, RN
• Taryn Banfield, DPT
• Madison Bangert, M.D
• Alize Vonique Bangerter
• Cara Bangerter
• Mikayla Bangerter

• All providers in Salt Lake City, UT
• Substance Abuse Rehabilitation Facility in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.