Douglass William Forsha, MD

Primary specialty

Legal MedicineTaxonomy code 173000000X

License

1850911205 Issued in UT

Practice address

10654 South River Heights Drive
Suite 210
South Jordan, UT 84095

Phone

(801) 569-1456

Fax

(801) 565-7931

NPI assigned

Jun 7, 2006

Last updated

Jan 17, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

Vanderbilt University School of Medicine, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jordan Valley Dermatology Center LLCGroup PAC ID 5890019707, 5 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jordan Valley Dermatology Center LLC

  • Dermatology Physician
  • West Jordan, UT
  • NPI 1558766477
  Medicare reassignment Care Compare group NPD
• Pilot Butte Dermatology, L.C.

  • Specialist
  • Evanston, WY
  • NPI 1871733238
  Authorized official Same address or phone

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642377600000",
    "number": "1285674671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10654 SOUTH RIVER HEIGHTS DRIVE",
            "address_2": "SUITE 210",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "84095",
            "telephone_number": "801-569-1456",
            "fax_number": "801-565-7931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10654 SOUTH RIVER HEIGHTS DRIVE",
            "address_2": "SUITE 210",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "84095",
            "telephone_number": "801-569-1456",
            "fax_number": "801-565-7931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORSHA",
        "first_name": "DOUGLASS",
        "middle_name": "WILLIAM",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2022-01-17",
        "certification_date": "2022-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "",
            "desc": "Legal Medicine",
            "state": "UT",
            "license": "1850911205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fojisoft Inc.
• Cheyenne Foote
• Samuel Force, PA-C
• James Ford
• Shannon Anne Ford, NP
• Lisa Forsyth
• Ricardo Fortmuller
• Foundation Physical Therapy
• Four Seasons Counseling and Wellness, LLC
• Stephanie Fowler, MA, CCC-SLP

• Legal Medicine in South Jordan, UT
• Providers in South Jordan, UT by specialty
• Legal Medicine in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.