Active NPI
Douglas L Packer, M.D.
- Clinical Cardiac Electrophysiology Physician
- Murray, UT
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Cardiac Electrophysiology Physician
- License
- 13534972-8905
- Practice address
- 5121 S Cottonwood St
Murray, UT 84107-5701 - Phone
- (801) 507-7000
- NPI assigned
- Jan 3, 2006
- Last updated
- Jan 9, 2024
- 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 |
|---|---|---|---|---|
| Clinical Cardiac Electrophysiology Physician | 207RC0001X | 13534972-8905 | UT | Primary |
Addresses
Primary practice location
5121 S Cottonwood St
Murray, UT 84107-5701
Mailing address
5121 S Cottonwood St
Murray, UT 84107-5701
Phone (801) 507-7000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN, UT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Cardiovascular Disease (Cardiology)
- Education
- Other, 1980
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
5121 S Cottonwood St
Murray, UT 84107-5701
Phone (801) 507-7000
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13534972-8905 | UT | MD | Clinical Cardiac Electrophysiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mayo Clinic Health System-St James | Current | Accepting new patients | |
| Ihc Health Services, Inc. | Current | Accepting new patients | |
| Mayo Clinic Health System-Lake City | Current | Accepting new patients | |
| Mayo Clinic Health System-Fairmont | Current | Accepting new patients | |
| Ihc Health Services Inc | Current | Accepting new patients | |
| Ihc Health Services Inc | Current | Accepting new patients |
Locations
404 W Fountain St
Albert Lea, MN 56007
Phone (507) 377-6285
800 Medical Center Dr
Fairmont, MN 56031
Phone (507) 238-8100
500 W Grant St
Lake City, MN 55041
Phone (651) 345-3321
1025 Marsh St
Mankato, MN 56001
Phone (507) 345-2623
200 1st St SW
Rochester, MN 55905
Phone (507) 266-4850
1101 Moulton and Parsons Dr
Saint James, MN 56081
Phone (507) 375-3261
400 C St
Salt Lake Cty, UT 84143
Phone (435) 688-4080
5121 S Cottonwood St
Salt Lake Cty, UT 84107
Phone (801) 408-8998
Organizations & group practices 6
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.
-
dba IMED Physicians Billing
- Multi-Specialty Clinic/Center
- Murray, UT
- NPI 1629260880
-
- Multi-Specialty Clinic/Center
- Fairmont, MN
- NPI 1366410862
-
- Multi-Specialty Clinic/Center
- Lake City, MN
- NPI 1164463659
-
- Multi-Specialty Clinic/Center
- Saint James, MN
- NPI 1023177730
-
dba St George Adolescent Partial Hospitalization
- Psychiatry Physician
- St George, UT
- NPI 1023843844
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136246400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704758400000",
"number": "1194703942",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5121 S COTTONWOOD ST",
"city": "MURRAY",
"state": "UT",
"postal_code": "841075701",
"telephone_number": "801-507-7000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5121 S COTTONWOOD ST",
"city": "MURRAY",
"state": "UT",
"postal_code": "841075701",
"telephone_number": "801-507-7000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PACKER",
"first_name": "DOUGLAS",
"middle_name": "L",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-03",
"last_updated": "2024-01-09",
"certification_date": "2024-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
"state": "UT",
"license": "13534972-8905",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Murray, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2024; 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.