Canyon Ridge Pain and Spine PC

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

License

6955001-1205 Issued in UT

Legal business name

CANYON RIDGE PAIN AND SPINE PC

Practice address

1551 Renaissance Towne Dr
Suite 460
Bountiful, UT 84010-7667

Phone

(801) 205-4116

Fax

(435) 986-9368

NPI assigned

Jul 22, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Raul Kem Weston, MDNPI 1902066988

Title

President

Phone

(801) 205-4116

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Raul Kem Weston, M.D.

  • Anesthesiology Physician
  • Bountiful, UT
  • NPI 1902066988
  Medicare reassignment Care Compare group NPD Authorized official
• Konneen Willis, PA

  • Medical Physician Assistant
  • Bountiful, UT
  • NPI 1861510240
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1311292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311292800000",
    "number": "1376821587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1551 RENAISSANCE TOWNE DR",
            "address_2": "SUITE 460",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840107667",
            "telephone_number": "801-205-4116",
            "fax_number": "435-986-9368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1551 RENAISSANCE TOWNE DR",
            "address_2": "SUITE 460",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840107667",
            "telephone_number": "801-205-4116",
            "fax_number": "435-986-9368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYON RIDGE PAIN AND SPINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-22",
        "last_updated": "2011-07-22",
        "status": "A",
        "authorized_official_last_name": "WESTON",
        "authorized_official_first_name": "RAUL",
        "authorized_official_middle_name": "KEM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "801-205-4116",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "UT",
            "license": "6955001-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Canale, MD
• Rebecca Canfield
• Gwen R Cannon
• Hyrum M Cannon, DDS
• Canyon Ridge Chiropractic, Inc.
• Lisa Cappelli
• Gina Markos Capps, CPNP
• Jennifer Rigby Cardinal, PHD, BCBA
• Kelci D Cardinal
• Shirlynn Rae Carey

• Interventional Pain Medicine Physician in Bountiful, UT
• Providers in Bountiful, UT by specialty
• Interventional Pain Medicine Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.