NPIMap

Organization Active NPI

FJM Basecamp

Doing business as FJM Medical Clinic-BaseCamp

  • Family Medicine Physician
  • Salt Lake City, UT
National Provider Identifier
1255858734
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
70786441205 Issued in UT
Legal business name
FJM BASECAMP
Doing business as
FJM Medical Clinic-BaseCamp
Practice address
185 S State St Ste 208
Salt Lake City, UT 84111-1558
Phone
(801) 821-5454
Fax
(801) 821-5455
NPI assigned
Aug 25, 2017
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
FUTURA MEDICAL CLINICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Darce A Latsis
Title
Operations Manager
Phone
(801) 441-1002

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 70786441205 UT Primary

Addresses

Primary practice location

185 S State St Ste 208
Salt Lake City, UT 84111-1558

Mailing address

560 S 300 E Ste 275
Salt Lake City, UT 84111-3586
Phone (801) 441-1002

Other names 1

  • FJM Medical Clinic-BaseCamp Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
46D2136657FJM Medical Clinic Basecamp185 S State Street, Suite 208, Salt Lake City, UT 84111Provider-performed microscopyApr 22, 2028

National Provider Directory

National Provider Directory
Tax ID family
Blendtec Health Center25 organizations share this tax ID, including this one
Part of
Blendtec Health Center

Other organizations with this tax ID 24

Organizations that report the same tax identification number in the National Provider Directory.

View all 24

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1503619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1255858734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "560 S 300 E STE 275",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841113586",
            "telephone_number": "801-441-1002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "185 S STATE ST STE 208",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841111558",
            "telephone_number": "801-821-5454",
            "fax_number": "801-821-5455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FJM BASECAMP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FUTURA MEDICAL CLINIC",
        "enumeration_date": "2017-08-25",
        "last_updated": "2022-07-21",
        "certification_date": "2020-01-30",
        "status": "A",
        "authorized_official_last_name": "LATSIS",
        "authorized_official_first_name": "DARCE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "801-441-1002"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "70786441205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FJM Medical Clinic-BaseCamp",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salt Lake City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.