NPIMap

Organization Active NPI

Mindful Mobile Medicine LLC

  • Internal Medicine Physician
  • Midvale, UT
National Provider Identifier
1245068626
Registry record updated Feb 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MINDFUL MOBILE MEDICINE LLC
Practice address
623 E Fort Union Blvd Ste 105
Midvale, UT 84047-5529
Phone
(801) 879-2664
NPI assigned
Jul 25, 2024
Last updated
Feb 10, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2025

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

Authorized official

Name
Tyler Young
Title
VP
Phone
(801) 879-2664

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Gerontology Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LG0600X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X

Addresses

Primary practice location

623 E Fort Union Blvd Ste 105
Midvale, UT 84047-5529

Mailing address

623 E Fort Union Blvd Ste 105
Midvale, UT 84047-5529
Phone (385) 412-1660

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241112004201 UT Part B Supplier - Clinic/Group Practice 1254865363 Receives reassigned benefits from 5 practitioners
Practice locations: Midvale, UT

National Provider Directory

National Provider Directory

Locations

623 E Fort Union Blvd
Ste 105
Midvale, UT 84047
Phone (385) 412-1660

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1721865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739145600000",
    "number": "1245068626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "623 E FORT UNION BLVD STE 105",
            "city": "MIDVALE",
            "state": "UT",
            "postal_code": "840475529",
            "telephone_number": "385-412-1660",
            "fax_number": "801-261-5856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "623 E FORT UNION BLVD STE 105",
            "city": "MIDVALE",
            "state": "UT",
            "postal_code": "840475529",
            "telephone_number": "801-879-2664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDFUL MOBILE MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-25",
        "last_updated": "2025-02-10",
        "certification_date": "2025-02-10",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "TYLER",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "801-879-2664"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Midvale, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 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.