Individual provider Active NPI

Brandon Seth Longenecker, DO

  • Obstetrics & Gynecology Physician
  • Heber City, UT
National Provider Identifier
1407196801
Registry record updated Apr 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
5101020315 Issued in MI
Practice address
380 E 1500 S Ste 202
Heber City, UT 84032-3942
Phone
(435) 657-4600
Fax
(435) 657-4615
NPI assigned
Feb 21, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 5101020315 MI Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

380 E 1500 S Ste 202
Heber City, UT 84032-3942

Mailing address

380 E 1500 S Ste 202
Heber City, UT 84032-3942
Phone (146) 565-7460

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
I20170606001799 UT Practitioner - Obstetrics/Gynecology 8921375361 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Practice addresses (Care Compare)

1473 S Hwy 40 E
Heber Valley, UT 84032-3522
Phone (435) 654-2500

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101020315MIMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services CurrentSince Jul 1, 2017 Accepting new patients
Ihc Health Services Inc Current Accepting new patients
Ihc Health Services, Inc. CurrentSince Jul 1, 2017 Accepting new patients
Ihc Health Services Inc Past Accepting new patients

Locations

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

380 E 1500 S
Ste 202
Heber City, UT 84032
Phone (435) 657-4600

454 E Medical Way
Heber City, UT 84032
Phone (435) 654-2500

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1361404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585785600000",
    "number": "1407196801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "380 E 1500 S STE 202",
            "city": "HEBER CITY",
            "state": "UT",
            "postal_code": "840323942",
            "telephone_number": "146-565-7460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 E 1500 S STE 202",
            "city": "HEBER CITY",
            "state": "UT",
            "postal_code": "840323942",
            "telephone_number": "435-657-4600",
            "fax_number": "435-657-4615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONGENECKER",
        "first_name": "BRANDON",
        "middle_name": "SETH",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-02-21",
        "last_updated": "2020-04-02",
        "certification_date": "2020-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MI",
            "license": "5101020315",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Heber City, UT

Sources for this page

Verify at the official NPI Registry.