NPIMap

Individual provider Active NPI

Shaun C Shurtliff, DO

  • Family Medicine Physician
  • Vernal, UT
National Provider Identifier
1285719294
Registry record updated Oct 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
3719171204 Issued in UT
Practice address
872 W Highway 40
Vernal, UT 84078-2416
Phone
(435) 781-8899
Fax
(435) 781-8898
NPI assigned
Oct 26, 2006
Last updated
Oct 28, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 28, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 3719171204 UT Primary

Addresses

Primary practice location

872 W Highway 40
Vernal, UT 84078-2416

Mailing address

175 N 100 W
Ste 103
Vernal, UT 84078-2049
Phone (435) 781-8899

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031227000010 UT Practitioner - Family Practice 0941108096 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Vernal Urgent Care LLCGroup PAC ID 5193149086, 3 clinicians
Ashley Valley Family PracticeGroup PAC ID 6406881747, 3 clinicians

Practice addresses (Care Compare)

872 W Hwy 40
Vernal, UT 84078-2416
Phone (435) 789-6677

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.17 of 100Reported as apm
Quality
80.65
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
3719171204UTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Vernal Urgent Care LLC CurrentSince Oct 3, 2018 Accepting new patients
Garfield County Past Accepting new patients
Garfield County Past Accepting new patients
Garfield County Past Accepting new patients
Garfield County Past Accepting new patients
Frances Mahon Deaconess Hospital Past Accepting new patients

Locations

175 N 100 W
Ste 103
Vernal, UT 84078
Phone (435) 781-1099

872 W Highway 40
Vernal, UT 84078
Phone (435) 781-8899

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EAGBDA/Endpoint/EAGBDA
  • Direct secure messaging: pbu8650@yourcarecommunity.org
  • Direct secure messaging: shaun.shurtliff@avfp.eclinicaldirectplus.com

Organizations & group practices 7

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.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603843200000",
    "number": "1285719294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 N 100 W",
            "address_2": "STE 103",
            "city": "VERNAL",
            "state": "UT",
            "postal_code": "840782049",
            "telephone_number": "435-781-8899",
            "fax_number": "435-781-8898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "872 W HIGHWAY 40",
            "city": "VERNAL",
            "state": "UT",
            "postal_code": "840782416",
            "telephone_number": "435-781-8899",
            "fax_number": "435-781-8898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHURTLIFF",
        "first_name": "SHAUN",
        "middle_name": "C",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-26",
        "last_updated": "2020-10-28",
        "certification_date": "2020-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "3719171204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vernal, UT

Sources for this page

Verify at the official NPI Registry.