Brock Bodily

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

11353289-8002 Issued in UT

Practice address

10623 S Redwood Rd # 101
South Jordan, UT 84095-2481

Phone

(801) 566-4242

NPI assigned

Jul 8, 2019

Last updated

Jul 8, 2019By 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 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• South Valley Orthomed, PLLC

  • Orthopaedic Surgery Physician
  • South Jordan, UT
  • NPI 1073048344
  NPD

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

{
    "created_epoch": "1562544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562544000000",
    "number": "1366004517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1265 N 850 E",
            "city": "PLEASANT GROVE",
            "state": "UT",
            "postal_code": "840621998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10623 S REDWOOD RD # 101",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840952481",
            "telephone_number": "801-566-4242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODILY",
        "first_name": "BROCK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-08",
        "last_updated": "2019-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "UT",
            "license": "11353289-8002",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blue Bee Counseling Services LLC
• Blue Theory Counseling LLC
• Verena Blume
• Jess Leland Bluth, DC
• John Ellis Boden, LPC
• Bodyworks Chiropractic Center Inc
• Bond Chiropractic Inc
• Roger Arie Bond, D.C.
• Trudy Bond, L.P.C.
• Lora Elizabeth Bonham, LCSW

• Surgical Physician Assistant in South Jordan, UT
• Providers in South Jordan, UT by specialty
• Surgical Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.