Shadow Mountain Family Medicine LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SHADOW MOUNTAIN FAMILY MEDICINE LLC

Practice address

3855 W 7800 S
Suite 100
West Jordan, UT 84088-5560

Phone

(801) 282-5952

Fax

(801) 282-5951

NPI assigned

Aug 5, 2008

Organization subpart

No

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

Authorized official

Name

David J. Kane

Title

VP

Phone

(801) 568-5999

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Chad Barnett, PA-C

  • Medical Physician Assistant
  • Riverton, UT
  • NPI 1912103615
  NPD (past)
• David F Castro, PA-C

  • Medical Physician Assistant
  • Ogden, UT
  • NPI 1427254135
  NPD (past)
• Jan M Castro, PA-C

  • Medical Physician Assistant
  • Ogden, UT
  • NPI 1235335944
  NPD (past)
• Kathie Ellen Coopersmith, M.D.

  • Pediatrics Physician
  • Ogden, UT
  • NPI 1447359039
  NPD (past)
• Isabel Cristina Lau, MD

  • Pediatrics Physician
  • Ogden, UT
  • NPI 1023288511
  NPD (past)
• Michael E Severance, PA-C

  • Physician Assistant
  • Ogden, UT
  • NPI 1942273149
  NPD (past)
• Kenneth Edward Stevenson, M.D.

  • Pediatrics Physician
  • Ogden, UT
  • NPI 1245326065
  NPD (past)
• Joseph Francis Kasper, MD

  • Family Medicine Physician
  • Fort Huachuca, AZ
  • NPI 1972581528
  NPD (past)

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

{
    "created_epoch": "1217894400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1244073600000",
    "number": "1225294697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3855 W 7800 S",
            "address_2": "SUITE 100",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840885560",
            "telephone_number": "801-282-5952",
            "fax_number": "801-282-5951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3855 W 7800 S",
            "address_2": "SUITE 100",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840885560",
            "telephone_number": "801-282-5952",
            "fax_number": "801-282-5951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADOW MOUNTAIN FAMILY MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-05",
        "last_updated": "2009-06-04",
        "status": "A",
        "authorized_official_last_name": "KANE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "801-568-5999"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1225294697",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sonya-Mae Servin
• Wade M Sessions, MD
• Tina Severson
• SGWJ Dental PLLC
• Devery Ann Shaddy, FNP
• Shadow Mountain Family Physicians
• Ashton Thomas Shaw
• Laurie N Shaw
• Stacey Ann Shaw, PHD, CSW
• Connor Sheffield

• Family Medicine Physician in West Jordan, UT
• Providers in West Jordan, UT by specialty
• Family Medicine Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.