Todd M Haderlie, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

187150-1205 Issued in UT

Practice address

1485 S Highway 40 Ste E
Heber City, UT 84032-3522

Phone

(435) 657-4400

NPI assigned

Aug 10, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WY

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

Family Practice

Education

University of Utah School of Medicine, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Lincoln County Hospital DistrictGroup PAC ID 4789580218, shared by 4 NPIs, 66 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Symbii Home Health Home health agency, Afton, WY, CCN 537073
• Premier Home Health Inc Home health agency, Thayne, WY, CCN 537304
• Star Valley Medical Center Hospital, Afton, WY, CCN 531313
• Mountain View Hospital Hospital, Idaho Falls, ID, CCN 130065

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: thaderlie625012@direct.ochin.org

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.

• North Lincoln County Hospital District

  • Critical Access Hospital
  • Afton, WY
  • NPI 1255376406
  Medicare reassignment NPD
• North Lincoln County Hospital District

  • Family Medicine Physician
  • Afton, WY
  • NPI 1730132523
  Medicare reassignment NPD
• Ihc Health Services Inc

  • Hospitalist Physician
  • Provo, UT
  • NPI 1134259294
  NPD (past)

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

• Mountain View Hospital LLC

  • General Acute Care Hospital
  • Idaho Falls, ID
  • NPI 1669462362
  Care Compare affiliation
• North Lincoln County Hospital District

  • Critical Access Hospital
  • Afton, WY
  • NPI 1255376406
  Care Compare affiliation
• Premier Home Health Inc

  • Case Management Agency
  • Thayne, WY
  • NPI 1902841000

  Home health agency

  Care Compare affiliation
• Star Valley Healthcare, Inc.

  • Home Health Agency
  • Afton, WY
  • NPI 1073090585
  Care Compare affiliation

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490918400000",
    "number": "1326059155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27128",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841270128",
            "telephone_number": "435-657-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1485 S HIGHWAY 40 STE E",
            "city": "HEBER CITY",
            "state": "UT",
            "postal_code": "840323522",
            "telephone_number": "435-657-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HADERLIE",
        "first_name": "TODD",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-10",
        "last_updated": "2017-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "187150-1205",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "UT",
            "license": "1871501205",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jamar Romanceles Grayson, D.O.
• William D Green, PT
• Gregory P Tayler MD Professional Corporation
• Donn Alan Grimes, DDS
• Sarah E Gunn, MA
• Richard Hagen, OTR/L
• William Bradley Hale, M.D.
• Joshua Lee Hall, PT, DPT
• Stacy Robinson Hall, RPH
• Melissa Ann Halliday, CCC-SLP

• Family Medicine Physician in Heber City, UT
• Providers in Heber City, UT by specialty
• Family Medicine Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2017; 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.