NPIMap

Individual provider Active NPI

Olivier Mutah Mulyangote, P.A.

  • Physician Assistant
  • Salt Lake City, UT
National Provider Identifier
1215262944
Registry record updated May 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
74589851206 Issued in UT
Practice address
3195 S Main St
Suite 200
Salt Lake City, UT 84115-3749
Phone
(801) 468-0354
Fax
(801) 468-0353
NPI assigned
Oct 14, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 74589851206 UT Primary

Addresses

Primary practice location

3195 S Main St
Suite 200
Salt Lake City, UT 84115-3749

Mailing address

3195 S Main St
Suite 200
Salt Lake City, UT 84115-3749
Phone (801) 468-0354

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address omulyangote5631@direct.med.utah.edu Direct University of Utah

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111024000685 UT Practitioner - Physician Assistant 7719150580 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Utah School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1525 W 2100
Salt Lake City, UT 84119-1407
Phone (801) 213-9900

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.01 of 100Reported as group
Quality
94.06
Promoting interoperability
100
Improvement activities
40
Cost
69.32

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
74589851206UTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Community Physicians Group CurrentSince Jan 1, 2023 Accepting new patients
State of Utah CurrentSince Jul 31, 2011 Accepting new patients
Health Clinics of Utah Current Accepting new patients
Health Clinics of Utah Current Accepting new patients
University of Utah Community Physicians Group Past Accepting new patients

Locations

1300 E Center St
Provo, UT 84606
Phone (801) 344-4215

1525 W 2100 S
Salt Lake City, UT 84119
Phone (801) 213-8841

168 N 1950 W
Ste 201
Slc, UT 84116
Phone (801) 213-2537

3195 S Main St
Ste 200
South Salt Lake, UT 84115
Phone (801) 468-0342

220 Millpond
Ste 100
Tooele, UT 84074
Phone (435) 843-3000

Interoperability endpoints

  • Direct secure messaging: omulyangote5631@direct.med.utah.edu

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 and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1255478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682985600000",
    "number": "1215262944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3195 S MAIN ST",
            "address_2": "SUITE 200",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841153749",
            "telephone_number": "801-468-0354",
            "fax_number": "801-468-0353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3195 S MAIN ST",
            "address_2": "SUITE 200",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841153749",
            "telephone_number": "801-468-0354",
            "fax_number": "801-468-0353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULYANGOTE",
        "first_name": "OLIVIER",
        "middle_name": "MUTAH",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-10-14",
        "last_updated": "2023-05-02",
        "certification_date": "2023-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "74589851206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "omulyangote5631@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.