Individual provider Active NPI

Kristin Elle Mitrovich, MD

  • Neurology Physician
  • Salt Lake City, UT
National Provider Identifier
1386088532
Registry record updated Mar 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
9164161-1205 Issued in UT
Practice address
5171 S Cottonwood St Ste 810
Salt Lake City, UT 84107-5705
Phone
(801) 507-9800
NPI assigned
Apr 18, 2013
Last updated
Mar 10, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Neurology Physician 2084N0400X DR.0058602 CO
Neurology Physician 2084N0400X 9164161-1205 UT Primary

Addresses

Primary practice location

5171 S Cottonwood St Ste 810
Salt Lake City, UT 84107-5705

Mailing address

PO Box 27128
Salt Lake City, UT 84127-0128

Other practice location 1

50 Medical Drive
Salt Lake City, UT 84132-0001
Phone (801) 581-2121

Other practice location 2

12605 E 16th Ave
Aurora, CO 80045-2545
Phone (720) 848-0000

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20181214002484 UT Practitioner - Neurology 2860719085 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Creighton University School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Practice addresses (Care Compare)

5171 S Cottonwood St
Suite 810
Murray, UT 84107-5705
Phone (801) 507-9800

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
DR.0058602COMDNeurology Physician
9164161-1205UTMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services, Inc. CurrentSince Sep 9, 2018 Accepting new patients
Ihc Health Services Inc Neurology CurrentSince Sep 9, 2018 Accepting new patients
Ihc Health Services Inc Current Accepting new patients

Locations

700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555

900 Round Valley Dr
Ste 110
Park City, UT 84060
Phone (435) 333-3535

5171 S Cottonwood St
Ste 810
Salt Lake City, UT 84107
Phone (801) 507-9800

5770 S 250 E
Ste 135
Salt Lake Cty, UT 84107
Phone (801) 263-3416

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

Organizations & group practices 3

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1366243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741564800000",
    "number": "1386088532",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5171 S COTTONWOOD ST STE 810",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841075705",
            "telephone_number": "801-507-9800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "50 Medical Drive",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841320001",
            "country_code": "US",
            "telephone_number": "801-581-2121",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12605 E 16th Ave",
            "address_purpose": "LOCATION",
            "city": "Aurora",
            "state": "CO",
            "postal_code": "800452545",
            "country_code": "US",
            "telephone_number": "720-848-0000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MITROVICH",
        "first_name": "KRISTIN",
        "middle_name": "ELLE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-18",
        "last_updated": "2025-03-10",
        "certification_date": "2025-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CO",
            "license": "DR.0058602",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "UT",
            "license": "9164161-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.