NPIMap

Individual provider Active NPI

Kevin Campbell, M.D.

  • Adult Reconstructive Orthopaedic Surgery Physician
  • Salt Lake City, UT
National Provider Identifier
1306251806
Registry record updated Jun 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Reconstructive Orthopaedic Surgery PhysicianTaxonomy code 207XS0114X
License
11268150-1205 Issued in UT
Practice address
590 S Wakara Way
Salt Lake City, UT 84108-1200
Phone
(801) 587-5400
NPI assigned
Jun 24, 2014
Last updated
Jun 10, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 125065467 IL
Adult Reconstructive Orthopaedic Surgery Physician 207XS0114X 11268150-1205 UT Primary

Addresses

Primary practice location

590 S Wakara Way
Salt Lake City, UT 84108-1200

Mailing address

590 S Wakara Way
Salt Lake City, UT 84108-1200
Phone (801) 587-5400

Other practice location 1

1611 W Harrison St Ste 300
Chicago, IL 60612-4861
Phone (312) 942-5850

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT, WI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190612000251 UT Practitioner - Orthopedic Surgery 0749513414 Reassigns benefits to 1 organization
I20200911000837 WI Practitioner - Orthopedic Surgery 0749513414 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
University of Wisconsin School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthopedic and Sports Institute of the Fox Valley S CGroup PAC ID 8628089331, 13 clinicians

Practice addresses (Care Compare)

1498 W S Park Ave
Oshkosh, WI 54902-6677
Phone (920) 560-1000

2105 E Enterprise Ave
Appleton, WI 54913-7862
Phone (920) 560-1000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement18
Knee replacement20

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125065467ILMDOrthopaedic Surgery Physician
11268150-1205UTMDAdult Reconstructive Orthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopedic and Sports Institute of the Fox Valley S C Orthopaedic Surgery CurrentSince May 1, 2021 Accepting new patients
University of Utah Adult Services Current Accepting new patients
University of Utah Adult Services CurrentSince May 17, 2019 Accepting new patients
University of Utah Adult Services CurrentSince May 17, 2019 Accepting new patients
Neurospine Center of Wisconsin, S.C. PastSince Jun 1, 2004 Accepting new patients

Locations

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

590 S Wakara Way
Slc, UT 84108
Phone (801) 587-7005

2105 E Enterprise Ave
Appleton, WI 54913
Phone (920) 560-1000

2105 E Enterprise Ave
#111
Appleton, WI 54913
Phone (920) 731-6611

2105 E Enterprise Ave
#112
Appleton, WI 54913
Phone (920) 731-3111

2105 E Enterprise Ave
Ste 101
Appleton, WI 54913
Phone (920) 560-1047

2105 E Enterprise Ave
Ste 111
Appleton, WI 54913
Phone (920) 560-1000

1498 W South Park Ave
Oshkosh, WI 54902
Phone (920) 560-1000

102 Grand Seasons Dr
Waupaca, WI 54981
Phone (715) 256-3408

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EBJABD

Organizations & group practices 5

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 7

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": "1403568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560124800000",
    "number": "1306251806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "590 S WAKARA WAY",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841081200",
            "telephone_number": "801-587-5400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "590 S WAKARA WAY",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841081200",
            "telephone_number": "801-587-5400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1611 W Harrison St Ste 300",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606124861",
            "country_code": "US",
            "telephone_number": "312-942-5850",
            "fax_number": "312-942-2040",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "KEVIN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-24",
        "last_updated": "2019-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "IL",
            "license": "125065467",
            "primary": false
        },
        {
            "code": "207XS0114X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery",
            "state": "UT",
            "license": "11268150-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.