Innovation Medical Group PC
Organization Active NPI Podiatrist · Salt Lake City, UT
NPI 1235526682 · NPPES record last updated Jul 26, 2026
Key facts
- NPI
- 1235526682
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Podiatrist 213E00000X
- Legal business name
- INNOVATION MEDICAL GROUP PC
- Practice address
- 6405 S 3000 E Ste 300
Salt Lake City, UT 84121-6977 - Phone
- (801) 266-3113
- Fax
- (801) 266-5633
- NPI assigned
- Apr 23, 2015
- Organization subpart
- No
Authorized official
- Name
- Taylor G Wright, DPM
- Title
- Ceo
- Phone
- (801) 266-3113
Practitioners 58
-
Thomas Bullock Simon, DPM
-
Miranda Arreola, FNP
-
Hope K Barkhurst, M.D.
-
Kelly Bennett, N.P.
-
Israel Bowers, DPM
-
Blake Burkert, M.D.
-
Vitina Marie Cosse, FNP
-
Echo Dashawn Favaloro, FNP-C, PMHNP-BC
-
Bethany Lynn Jones, AGPNP
-
Jesse Alexander Keele, APRN-CNP
-
Kathryn Ann Langmuir, APRN-CNP
-
Milagros Mirdo, CNP
-
Allison Mae Porter-Prieskorn, FNP-C
-
Rebecca Ann Schmidt, NP-PMHNP
-
Lindsey Sarah Schultz, PA-C
-
Karen Tapia, NP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 32D2302130 | Innovation Medical Group | Certificate of waiver | Apr 3, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in UT, NM, CO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150804003913 | UT | Part B Supplier - Clinic/Group Practice | 8426362450 |
Receives reassigned benefits from 28 practitioners Practice locations: Blanding, UT; Layton, UT; Monticello, UT; Provo, UT; Salt Lake City, UT; St George, UT |
| O20211222001412 | NM | Part B Supplier - Clinic/Group Practice | 8426362450 |
Receives reassigned benefits from 18 practitioners Practice locations: Aztec, NM; Farmington, NM; Gallup, NM |
| O20220204000067 | CO | Part B Supplier - Clinic/Group Practice | 8426362450 |
Receives reassigned benefits from 22 practitioners Practice locations: Cortez, CO; Durango, CO; Pagosa Springs, CO; Silverton, CO |
National Provider Directory
Locations
1280 N Mildred Rd
Cortez, CO 81321
Phone (970) 565-9500
1125 S Camino del Rio
Ste 300B
Durango, CO 81303
Phone (970) 459-1025
1125 S Camino del Rio
Ste 300
Durango, CO 81303
575 Rivergate Ln
Unit 109
Durango, CO 81301
Phone (970) 382-8292
1125 S Camino del Rio
#300B
Durango, CO 81303
Phone (970) 659-9850
27B Talisman Dr
Unit 1
Pagosa Springs, CO 81147
3360 Washington Pkwy
Idaho Falls, ID 83404
Phone (208) 932-7024
745 S Progress Ave
Ste 150
Meridian, ID 83642
Phone (208) 813-1958
3180 N Butler Ave
Bldg 300B
Farmington, NM 87401
Phone (505) 327-9196
4760 N Butler Ave
Ste B2
Farmington, NM 87401
Phone (505) 324-6300
4740 N Butler Ave
Farmington, NM 87401
Phone (505) 324-6300
1900 E Historic Highway 66
Ste 1
Gallup, NM 87301
Phone (505) 324-6300
7150 W Sunset Rd
Ste 110
Las Vegas, NV 89113
Phone (702) 703-2526
3152 N University Ave
Ste 201
Provo, UT 84604
3152 N University Ave
Ste 240
Provo, UT 84604
Phone (801) 900-5655
6405 S 3000 E
Ste 201
Salt Lake City, UT 84121
965 E 700 S
Ste 105
St George, UT 84790
Phone (435) 218-7770
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse |
163W00000X | |||
| Infusion Therapy Registered Nurse |
163WI0500X | |||
| Wound Care Registered Nurse |
163WW0000X | |||
| Family Medicine Physician |
207Q00000X | |||
| Anatomic Pathology & Clinical Pathology Physician |
207ZP0102X | |||
| Surgery Physician |
208600000X | |||
| Podiatrist |
213E00000X | Yes | ||
| Foot & Ankle Surgery Podiatrist |
213ES0103X | |||
| Occupational Therapist |
225X00000X | |||
| Vascular-Interventional Technology Radiologic Technologist |
2471V0106X | |||
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Physician Assistant |
363A00000X | |||
| Community Health Nurse Practitioner |
363LC1500X | |||
| Family Nurse Practitioner |
363LF0000X | |||
| Psychiatric/Mental Health Nurse Practitioner |
363LP0808X |
Addresses
Primary practice location
6405 S 3000 E Ste 300
Salt Lake City, UT 84121-6977
Mailing address
6405 S 3000 E Ste 300
Salt Lake City, UT 84121-6977
Phone (801) 266-3113
Other practice location 1
3360 S 15th E
Idaho Falls, ID 83404-8321
Phone (208) 932-7024
Other practice location 2
6405 S 3000 E Ste 201
Salt Lake City, UT 84121-6990
Phone (801) 266-3113
Other practice location 3
27B Talisman Dr Unit 2
Pagosa Springs, CO 81147-7914
Phone (970) 903-9853
Other practice location 4
2095 N Dolores Rd
Cortez, CO 81321-8924
Phone (970) 564-8086
Other practice location 5
1125 S Camino Del Rio Ste 300B
Durango, CO 81303-6886
Phone (970) 659-9850
Other practice location 6
745 S Progress Ave Ste 150
Meridian, ID 83642-5610
Phone (208) 813-1958
Other practice location 7
406 S Park Ave
Aztec, NM 87410
Phone (505) 334-2852
Other practice location 8
1315 Snowden St
Silverton, CO 81433-5108
Phone (970) 903-9853
Other practice location 9
4760 N Butler Ave Ste B2
Farmington, NM 87401-0816
Phone (505) 324-6300
Other practice location 10
3152 N University Ave
Suite 240
Provo, UT 84604
Phone (801) 900-5655
Other practice location 11
1900 E Historic Highway 66 Ste 1
Gallup, NM 87301-4883
Phone (505) 324-6300
Other practice location 12
16 E 300 S
Monticello, UT 84535
Phone (435) 270-0271
Other practice location 13
965 E 700 S Ste 105
St George, UT 84790-4084
Phone (435) 775-2324
Other practice location 14
836 S Angel St Ste 102
Layton, UT 84041-3687
Phone (435) 291-1375
Other practice location 15
4740 N Butler Ave
Farmington, NM 87401-0826
Phone (505) 324-6300
Other practice location 16
3360 Washington Pkwy
Idaho Falls, ID 83404-8332
Phone (208) 932-7024
Other practice location 17
270 E 8th Ave Ste N102
Durango, CO 81301-5708
Phone (801) 266-3113
Other practice location 18
46 N Main St
Blanding, UT 84511-2830
Phone (435) 270-0271
Other names
- Innovation Medical Group
Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 26, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.