Pediatric Emergency Medicine Department of University of Utah

Primary specialty

Pediatric Emergency Medicine (Pediatrics) PhysicianTaxonomy code 2080P0204X

Legal business name

PEDIATRIC EMERGENCY MEDICINE DEPARTMENT OF UNIVERSITY OF UTAH

Practice address

100 N Medical Dr
Salt Lake City, UT 84113-1103

Phone

(801) 588-2233

Fax

(801) 588-2236

NPI assigned

Jun 2, 2006

Last updated

Sep 6, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Edward B Clark, MD

Title

Chair

Phone

(801) 587-7400

Specialties & licenses 2

Addresses

Other identifiers 3

Locations

Practitioners 4

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.

• Brian Pierce Good, M.D.

  • Pediatrics Physician
  • South Jordan, UT
  • NPI 1770688335
  NPD (past)
• Renee Olesen, MD

  • Pediatrics Physician
  • West Jordan, UT
  • NPI 1578786851
  NPD (past)
• Kenneth Jenson Bramwell, MD

  • Emergency Medicine Physician
  • Boise, ID
  • NPI 1124065214
  NPD (past)
• Paul A Bryan, MD

  • Emergency Medicine Physician
  • Torrance, CA
  • NPI 1396786315
  NPD (past)

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315267200000",
    "number": "1275570665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "295 CHIPETA WAY",
            "address_2": "U OF U SOM DEPT OF PEDIATRICS",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841081220",
            "telephone_number": "801-587-7400",
            "fax_number": "801-587-7417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N MEDICAL DR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841131103",
            "telephone_number": "801-588-2233",
            "fax_number": "801-588-2236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC EMERGENCY MEDICINE DEPARTMENT OF UNIVERSITY OF UTAH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-02",
        "last_updated": "2011-09-06",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CHAIR",
        "authorized_official_telephone_number": "801-587-7400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121335100",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807146900",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100507107",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pediatric Anesthesiologists Inc
• Pediatric Behavioral Health
• Pediatric Bone Marrow Transplant Department of University of Utah
• Pediatric Cardiology Department of University of Utah
• Pediatric Critical Care Department of University of Utah
• Pediatric Emergency Sedation Service
• Pediatric Endocrinology Department of University of Utah
• Pediatric Gastroenterology Department of University of Utah
• Pediatric Genetics Department of University of Utah
• Pediatric Genetics Department of University of Utah

• Pediatric Emergency Medicine (Pediatrics) Physician in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Pediatric Emergency Medicine (Pediatrics) Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2011; 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.