Active NPI
Bethany A. Lueck, MD
- Neuroradiology Physician
- Salt Lake City, UT
National Provider Identifier
1194380683
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neuroradiology Physician
- License
- 14206966-1205
- Practice address
- 30 N Mario Capecchi RM 2S100
400 W Pueblo Street
Salt Lake City, UT 84112 - Phone
- (801) 581-2121
- Fax
- (805) 569-7317
- NPI assigned
- May 9, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | ME149484 | FL | |
| Neuroradiology Physician | 2085N0700X | 14206966-1205 | UT | Primary |
Addresses
Primary practice location
30 N Mario Capecchi RM 2S100
400 W Pueblo Street
Salt Lake City, UT 84112
Mailing address
30 N Mario Capecchi RM 2S100
400 W Pueblo Street
Salt Lake City, UT 84112
Phone (801) 581-2121
Other practice location 1
SBCH, Medical Education
400 W Pueblo Street
Santa Barbara, CA 93105
Phone (805) 569-7316
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14206966-1205 | UT | MD | Neuroradiology Physician |
| ME149484 | FL | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1557360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1741651200000",
"number": "1194380683",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 N MARIO CAPECCHI RM 2S100",
"address_2": "400 W PUEBLO STREET",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "84112",
"telephone_number": "801-581-2121",
"fax_number": "805-569-7317"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 N MARIO CAPECCHI RM 2S100",
"address_2": "400 W PUEBLO STREET",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "84112",
"telephone_number": "801-581-2121",
"fax_number": "805-569-7317"
}
],
"practiceLocations": [
{
"address_1": "SBCH, Medical Education",
"address_2": "400 W Pueblo Street",
"address_purpose": "LOCATION",
"city": "Santa Barbara",
"state": "CA",
"postal_code": "93105",
"country_code": "US",
"telephone_number": "805-569-7316",
"fax_number": "805-569-7317",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LUECK",
"first_name": "BETHANY",
"middle_name": "A.",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-05-09",
"last_updated": "2025-03-11",
"certification_date": "2025-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "FL",
"license": "ME149484",
"primary": false
},
{
"code": "2085N0700X",
"taxonomy_group": "",
"desc": "Radiology, Neuroradiology",
"state": "UT",
"license": "14206966-1205",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2025; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.