NPIMap

Organization Active NPI

Ultimate Sports Regenerative Medicine

  • Nurse Practitioner
  • South Jordan, UT
National Provider Identifier
1366989931
Registry record updated Jan 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
347183-4405 Issued in UT
Legal business name
ULTIMATE SPORTS REGENERATIVE MEDICINE
Practice address
1098 W. South Jordan Pkwy
Suite 101
South Jordan, UT 84095
Phone
(801) 254-5800
Fax
(801) 254-1696
NPI assigned
Jan 20, 2017
Last updated
Jan 20, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
ULTIMATE SPORTS REGENERATIVE MEDICINEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 20, 2017

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

Authorized official

Name
Patrick GarciaNPI 1972804946
Title
Direct Owner
Phone
(801) 254-5800

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Independent Medical Examiner ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NI0013X 7058178-1202 UT
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X 347183-4405 UT Primary

Addresses

Primary practice location

1098 W. South Jordan Pkwy
Suite 101
South Jordan, UT 84095

Mailing address

1098 W South Jordan Pkwy
Suite 101
South Jordan, UT 84095-9366
Phone (801) 254-5800

National Provider Directory

National Provider Directory
Part of
Ultimate Sports Regen Med

Locations

1098 W South Jordan Pkwy
Ste 101
South Jordan, UT 84095
Phone (801) 254-5800

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1484870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484870400000",
    "number": "1366989931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1098 W SOUTH JORDAN PKWY",
            "address_2": "SUITE 101",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840959366",
            "telephone_number": "801-254-5800",
            "fax_number": "801-254-1696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1098 W. SOUTH JORDAN PKWY",
            "address_2": "SUITE 101",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "84095",
            "telephone_number": "801-254-5800",
            "fax_number": "801-254-1696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ULTIMATE SPORTS REGENERATIVE MEDICINE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ULTIMATE SPORTS REGENERATIVE MEDICINE",
        "enumeration_date": "2017-01-20",
        "last_updated": "2017-01-20",
        "status": "A",
        "authorized_official_last_name": "GARCIA",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_title_or_position": "DIRECT OWNER",
        "authorized_official_telephone_number": "801-254-5800"
    },
    "taxonomies": [
        {
            "code": "111NI0013X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Independent Medical Examiner",
            "state": "UT",
            "license": "7058178-1202",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "UT",
            "license": "347183-4405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Jordan, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2017; 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.