NPIMap

Organization Active NPI

Neural Effects

  • Nurse Practitioner
  • Provo, UT
National Provider Identifier
1194330118
Registry record updated Apr 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
NEURAL EFFECTS
Practice address
320 River Park Dr Ste 255
Provo, UT 84604-6065
Phone
(801) 616-3675
Fax
(385) 225-9313
NPI assigned
Sep 15, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2024

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

Authorized official

Name
Mr. Jefferson B Gaufin
Title
Ceo
Phone
(801) 616-3675

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

320 River Park Dr Ste 255
Provo, UT 84604-6065

Mailing address

320 River Park Dr Ste 255
Provo, UT 84604-6065
Phone (801) 616-3675

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210202001380 UT Part B Supplier - Clinic/Group Practice 3072927094 Receives reassigned benefits from 6 practitioners
Practice locations: Provo, UT

National Provider Directory

National Provider Directory

Locations

1055 N 300 W
Ste 410
Provo, UT 84604
Phone (801) 225-5407

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1600128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714003200000",
    "number": "1194330118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 RIVER PARK DR STE 255",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846046065",
            "telephone_number": "801-616-3675",
            "fax_number": "385-225-9313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 RIVER PARK DR STE 255",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846046065",
            "telephone_number": "801-616-3675",
            "fax_number": "385-225-9313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEURAL EFFECTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-15",
        "last_updated": "2024-04-25",
        "certification_date": "2024-04-25",
        "status": "A",
        "authorized_official_last_name": "GAUFIN",
        "authorized_official_first_name": "JEFFERSON",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "801-616-3675",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Provo, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2024; 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.