NPIMap

Organization Active NPI

Utah Podiatry Group LLC

  • Foot & Ankle Surgery Podiatrist
  • Park City, UT
National Provider Identifier
1205569100
Registry record updated Oct 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
Legal business name
UTAH PODIATRY GROUP LLC
Practice address
1840 Sun Peak Dr
Park City, UT 84098-6732
Phone
(801) 505-5277
Fax
(801) 505-5280
NPI assigned
Jul 7, 2022
Organization subpart
Yes
Parent organization
UTAH PODIATRY GROUP LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 27, 2025

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

Authorized official

Name
Scott A Clark
Title
DPM
Phone
(801) 505-5277

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213E00000X
Foot & Ankle Surgery PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213ES0103X Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

1840 Sun Peak Dr
Park City, UT 84098-6732

Mailing address

PO Box 849795
Los Angeles, CA 90084-9795
Phone (801) 505-5277

Other names 1

  • Advanced Foot And Ankle Center Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210329001513 UT DME Supplier - Physician - Podiatry 2163592379 Practice locations: Park City, UT

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Utah Podiary Group PC13 organizations share this tax ID, including this one
Part of
Utah Podiary Group PC

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

24 S 1100 E
Ste 210
Salt Lake Cty, UT 84102
Phone (385) 286-4747

NPI Registry JSON

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

{
    "created_epoch": "1657152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761523200000",
    "number": "1205569100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 849795",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900849795",
            "telephone_number": "801-505-5277",
            "fax_number": "801-505-5280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1840 SUN PEAK DR",
            "city": "PARK CITY",
            "state": "UT",
            "postal_code": "840986732",
            "telephone_number": "801-505-5277",
            "fax_number": "801-505-5280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UTAH PODIATRY GROUP LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "UTAH PODIATRY GROUP LLC",
        "enumeration_date": "2022-07-07",
        "last_updated": "2025-10-27",
        "certification_date": "2025-10-27",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DPM",
        "authorized_official_telephone_number": "801-505-5277"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Foot And Ankle Center",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Advanced Foot And Ankle Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Park City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2025; 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.