Individual provider Active NPI

Daniel W Egan, M.D.

  • Family Medicine Physician
  • Alpine, UT
National Provider Identifier
1417066564
Registry record updated Mar 30, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
3460321205 Issued in UT
Practice address
155 W Canyon Crest Rd
Suite 200
Alpine, UT 84004-1819
Phone
(801) 763-9851
Fax
(801) 763-9852
NPI assigned
Aug 30, 2006
Last updated
Mar 30, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 3460321205 UT Primary

Addresses

Primary practice location

155 W Canyon Crest Rd
Suite 200
Alpine, UT 84004-1819

Mailing address

155 W Canyon Crest Rd
Suite 200
Alpine, UT 84004-1819
Phone (801) 763-9851

Other identifiers 1

IdentifierTypeStateIssuer
D4750MedicaidUT

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
I20031122000117 UT Practitioner - Family Practice 2264336023 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
George Washington University School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

155 W Canyon Crest Rd
Suite 200
Alpine, UT 84004-1966
Phone (801) 763-9851

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3460321205UTMDFamily Medicine Physician

Organizations & group practices 1

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 2

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": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1269907200000",
    "number": "1417066564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 W CANYON CREST RD",
            "address_2": "SUITE 200",
            "city": "ALPINE",
            "state": "UT",
            "postal_code": "840041819",
            "telephone_number": "801-763-9851",
            "fax_number": "801-763-9852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 W CANYON CREST RD",
            "address_2": "SUITE 200",
            "city": "ALPINE",
            "state": "UT",
            "postal_code": "840041819",
            "telephone_number": "801-763-9851",
            "fax_number": "801-763-9852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EGAN",
        "first_name": "DANIEL",
        "middle_name": "W",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2010-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "3460321205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D4750",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Alpine, UT

Sources for this page

Verify at the official NPI Registry.