Kimball Lael Christianson, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

10926114-1205 Issued in UT

Practice address

1055 N 500 W
Suite 112, BLDG. C
Provo, UT 84604

Phone

(801) 812-4624

Fax

(801) 812-4699

NPI assigned

May 1, 2008

Last updated

Dec 8, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Other identifiers 1

Electronic endpoints 1

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

Diagnostic Radiology

Education

Vanderbilt University School of Medicine, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Revere Health PCGroup PAC ID 7517868508, 407 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Timpanogos Regional Hospital Hospital, Orem, UT, CCN 460052
• Holy Cross Hospital-Jordan Valley Hospital, West Jordan, UT, CCN 460051
• Central Valley Medical Center - Cah Hospital, Nephi, UT, CCN 461304
• Mountain View Hospital Hospital, Payson, UT, CCN 460013

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kimballchristianson@cuccu.allscriptsdirect.net

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.

• Revere Health PC

  dba Revere Health

  • Multi-Specialty Clinic/Center
  • Provo, UT
  • NPI 1093764805
  Medicare reassignment Care Compare group NPD
• Revere Health PC

  dba Revere Health

  • Multi-Specialty Clinic/Center
  • Spanish Fork, UT
  • NPI 1851142285
  NPD

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

• Catholic Health Initiatives Colorado

  dba Holy Cross Hospital - Jordan Valley

  • General Acute Care Hospital
  • West Jordan, UT
  • NPI 1801591391
  Care Compare affiliation
• Central Valley Medical Center

  • Critical Access Hospital
  • Nephi, UT
  • NPI 1881658110
  Care Compare affiliation
• Central Valley Medical Center

  dba Nephi Medical Clinic

  • Family Medicine Physician
  • Nephi, UT
  • NPI 1992724975

  Hospital

  Care Compare affiliation
• Mountain View Hospital, Inc.

  dba Mountain View Hospital

  • General Acute Care Hospital
  • Payson, UT
  • NPI 1487607669
  Care Compare affiliation
• Timpanogos Regional Medical Services, Inc.

  dba Timpanogos Regional Hospital

  • General Acute Care Hospital
  • Orem, UT
  • NPI 1497702195
  Care Compare affiliation

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

{
    "created_epoch": "1209600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701993600000",
    "number": "1316113228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 N 500 W",
            "address_2": "ATTN. CREDENTIALING",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846044649",
            "telephone_number": "801-354-8225",
            "fax_number": "801-418-0941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 N 500 W",
            "address_2": "SUITE 112, BLDG. C",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "84604",
            "telephone_number": "801-812-4624",
            "fax_number": "801-812-4699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHRISTIANSON",
        "first_name": "KIMBALL",
        "middle_name": "LAEL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-01",
        "last_updated": "2023-12-08",
        "certification_date": "2023-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NC",
            "license": "135137",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NC",
            "license": "2010-00277",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OR",
            "license": "MD153988",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "ID",
            "license": "M-11249",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "UT",
            "license": "10926114-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1306895016",
            "state": "ID"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "medreview@reverehealth.com",
            "affiliation": "Y",
            "affiliationName": "Central Utah Clinic, P.C.",
            "address_1": "1055 N 500 W",
            "address_2": "Suite 112, Bldg. C",
            "city": "Provo",
            "state": "UT",
            "country_code": "US",
            "postal_code": "84604",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kelsie Christiansen
• Rebecca Christiansen
• Suelly Christiansen
• Ashley Christianson, FNP-C
• Boone R Christianson, LMFT
• Marlin L Christianson, MD
• Molly Christianson
• Annie E Christofferson, MS, ATC, LAT
• Christopher Gordon DO, LLC
• Tanica Christopherson

• Diagnostic Radiology Physician in Provo, UT
• Providers in Provo, UT by specialty
• Diagnostic Radiology Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2023; 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.