Active NPI
Clydeeve A Shreve, DPM
- Podiatrist
- Ogden, UT
National Provider Identifier
1225129117
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- 101694-0501
- Practice address
- 5640 Wasatch Dr
Suite F
Ogden, UT 84403-4902 - Phone
- (801) 392-7507
- Fax
- (801) 393-0725
- NPI assigned
- Sep 27, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Podiatrist | 213E00000X | 101694-0501 | UT | Primary |
Addresses
Primary practice location
5640 Wasatch Dr
Suite F
Ogden, UT 84403-4902
Mailing address
5640 Wasatch Dr
Suite F
Ogden, UT 84403-4902
Phone (801) 392-7507
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5177150001 | Other | UT | DEMERK PROVIDER ID |
| P00100541 | Other | UT | RR MEDICARE PROVIDER ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 101694-0501 | UT | MD | Podiatrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1225129117",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5640 WASATCH DR",
"address_2": "SUITE F",
"city": "OGDEN",
"state": "UT",
"postal_code": "844034902",
"telephone_number": "801-392-7507",
"fax_number": "801-393-0725"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5640 WASATCH DR",
"address_2": "SUITE F",
"city": "OGDEN",
"state": "UT",
"postal_code": "844034902",
"telephone_number": "801-392-7507",
"fax_number": "801-393-0725"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHREVE",
"first_name": "CLYDEEVE",
"middle_name": "A",
"credential": "DPM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-27",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "UT",
"license": "101694-0501",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEMERK PROVIDER ID",
"identifier": "5177150001",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE PROVIDER ID",
"identifier": "P00100541",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ogden, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.