Samuel Mark Bertoch, FNP-C
Individual provider Active NPI Nurse Practitioner · Roosevelt, UT
NPI 1417525544 · NPPES record last updated Jun 15, 2021
Key facts
- NPI
- 1417525544
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 327174-4405 (UT)
- Practice address
- 2750 North 2762 West
Roosevelt, UT 84066 - Phone
- (435) 722-9250
- NPI assigned
- Jun 15, 2021
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 12
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Northeastern Utah Medical Group
Uintah Basin Medical Center
Practice addresses (Care Compare)
210 W 300
Roosevelt, UT 84066-2336
Phone (435) 722-4691
250 W 300
Roosevelt, UT 84066-2336
379 N 500
Vernal, UT 84078-1956
Phone (435) 781-2030
Hospital & facility affiliations
- Uintah Basin Medical Center
- Ashley Regional Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 89.32 of 100
- Quality
- 71.89
- Promoting interoperability
- 100
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210823002405 | UT | Practitioner - Nurse Practitioner | 7810392271 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northeastern Utah Medical Group | Current |
Accepting new patients | |
| Uintah Basin Medical Center | Current |
Accepting new patients | |
| Uintah Basin Medical Center | Current |
Accepting new patients | |
| Northeastern Utah Medical Group | Current |
Accepting new patients |
Locations
50 E 200 S
Duchesne, UT 84021
Phone (435) 738-2426
210 W 300 N
Roosevelt, UT 84066
Phone (435) 722-4691
210 W 300 N
Ste 101
Roosevelt, UT 84066
250 W 300 N
#752
Roosevelt, UT 84066
Phone (435) 722-4691
38080 W State Road 35
Tabiona, UT 84072
Phone (435) 848-5509
405 N 500 W
Vernal, UT 84078
Phone (435) 781-2335
150 W 100 N
Ste S101
Vernal, UT 84078
Phone (435) 722-6144
475 N 500 W
Vernal, UT 84078
Phone (435) 781-2030
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 327174-4405 | UT | Yes |
Addresses
Primary practice location
2750 North 2762 West
Roosevelt, UT 84066
Mailing address
2750 North 2762 West
Roosevelt, UT 84066
Phone (435) 722-9250
Other providers in Roosevelt, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 15, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.