Individual provider Active NPI

Nicole Pershing, M.D.

  • Pediatric Infectious Diseases Physician
  • Salt Lake City, UT
National Provider Identifier
1306231808
Registry record updated Jun 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Infectious Diseases PhysicianTaxonomy code 2080P0208X
License
10104218-1205 Issued in UT
Practice address
100 N Mario Capecchi Dr
Pediatric Residency Office
Salt Lake City, UT 84113-1103
Phone
(801) 662-5700
NPI assigned
Apr 1, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 1, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Infectious Diseases Physician 2080P0208X 10104218-1205 UT Primary

Addresses

Primary practice location

100 N Mario Capecchi Dr
Pediatric Residency Office
Salt Lake City, UT 84113-1103

Mailing address

100 N Mario Capecchi Dr
Pediatric Residency Office
Salt Lake City, UT 84113-1103

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address NPERSHING149098@DIRECT.MED.UTAH.EDU Direct University of Utah

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20220512002710 UT Practitioner - Pediatric Medicine 3870873243 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Pediatric Services Pediatric Infectious Diseases CurrentSince Apr 15, 2022 Accepting new patients
University of Utah Pediatric Services Current Accepting new patients
University of Utah Pediatric Services CurrentSince Apr 15, 2022 Accepting new patients
University of Utah Pediatric Services Past Accepting new patients

Locations

127 S 500 E
Ste 400B
Salt Lake City, UT 84102
Phone (801) 587-6478

81 N Mario Capecchi Dr
Slc, UT 84113
Phone (801) 662-5700

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

100 N Mario Capecchi Dr
Slc, UT 84113
Phone (801) 587-7109

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1427846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654041600000",
    "number": "1306231808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N MARIO CAPECCHI DR",
            "address_2": "PEDIATRIC RESIDENCY OFFICE",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841131103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N MARIO CAPECCHI DR",
            "address_2": "PEDIATRIC RESIDENCY OFFICE",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841131103",
            "telephone_number": "801-662-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERSHING",
        "first_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-04-01",
        "last_updated": "2022-06-01",
        "certification_date": "2022-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0208X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Infectious Diseases",
            "state": "UT",
            "license": "10104218-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "NPERSHING149098@DIRECT.MED.UTAH.EDU",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.