Natalie Grevelink, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

12779730-1206 Issued in UT

Practice address

1526 Ute Blvd Ste 104
Park City, UT 84098-7575

Phone

(435) 602-1918

Fax

(435) 731-8109

NPI assigned

May 10, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

University of Florida College of Medicine, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Dermatology House PCGroup PAC ID 9335411446, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• The Dermatology House PC

  • Dermatology Physician
  • Park City, UT
  • NPI 1316470750
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691366400000",
    "number": "1407060908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1526 UTE BLVD STE 104",
            "city": "PARK CITY",
            "state": "UT",
            "postal_code": "840987575",
            "telephone_number": "435-602-1918",
            "fax_number": "435-731-8109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1526 UTE BLVD STE 104",
            "city": "PARK CITY",
            "state": "UT",
            "postal_code": "840987575",
            "telephone_number": "435-602-1918",
            "fax_number": "435-731-8109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREVELINK",
        "first_name": "NATALIE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-10",
        "last_updated": "2023-08-07",
        "certification_date": "2023-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "12779730-1206",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MA",
            "license": "AP1948",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "12779750-1206",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Anne Gomez, RN, MSN
• Jeffrey H Gordon I, DMD
• Robert S Gorelik, LCSW
• Rachel Graham
• Natasha Greene, MD
• Sonya Grey
• Alexandra Gribbin, P.T., D.P.T
• Matthew Melvin Griffeth, D.M.D.
• Gabrielle Grisoni
• Joshua Gruhl, MD

• Physician Assistant in Park City, UT
• Providers in Park City, UT by specialty
• Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2023; 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.