Douglas Lamar Fillmore, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

4945215-1205 Issued in UT

Practice address

1055 N 500 W
Suite 121
Provo, UT 84604-3305

Phone

(801) 373-7350

Fax

(801) 812-5401

NPI assigned

Sep 27, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

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

Other, 2001

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)

Hospital & facility affiliations

• Intermountain Health Utah Valley Hospital Hospital, Provo, UT, CCN 460001

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Ihc Health Services Inc

  • Multi-Specialty Clinic/Center
  • Sandy, UT
  • NPI 1942325154
  Medicare reassignment Care Compare group
• Ihc Health Services Inc

  dba Orthopedic Specialty Group - TOSH

  • Orthopaedic Surgery Physician
  • Murray, UT
  • NPI 1295866051
  NPD
• Ihc Health Services, Inc.

  dba St George Adolescent Partial Hospitalization

  • Psychiatry Physician
  • St George, UT
  • NPI 1023843844
  NPD
• Ihc Health Services Inc

  dba Orem Community Hospital Physicians

  • Multi-Specialty Clinic/Center
  • Orem, UT
  • NPI 1588601124
  NPD (past)

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

• Ihc Health Services, Inc.

  dba Intermountain Health Utah Valley Hospital

  • General Acute Care Hospital
  • Provo, UT
  • NPI 1114025491
  Care Compare affiliation
• Ihc Health Services, Inc.

  dba Intermountain Health Infusion Center- Spanish Fork, A Service of Utah Valley Hospital

  • Infusion Therapy Clinic/Center
  • Spanish Fork, UT
  • NPI 1679426944

  Hospital

  Care Compare affiliation
• Ihc Health Services, Inc.

  dba Intermountain Health Infusion Center- American Fork, A Service of Utah Valley Hospital

  • Infusion Therapy Clinic/Center
  • American Fork, UT
  • NPI 1982557252

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192406400000",
    "number": "1447341193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 N 500 W",
            "address_2": "CREDENTIALING DEPARTMENT",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043305",
            "telephone_number": "801-354-8215",
            "fax_number": "801-429-8180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 N 500 W",
            "address_2": "SUITE 121",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043305",
            "telephone_number": "801-373-7350",
            "fax_number": "801-812-5401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FILLMORE",
        "first_name": "DOUGLAS",
        "middle_name": "LAMAR",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-27",
        "last_updated": "2007-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "4945215-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IHC",
            "identifier": "107012276106",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Lynn Fields, MBA
• Tyler Jason Fieldsted, DO
• Linda Madsen Fifita, MSWI
• Sione Tauaalo Fifita, HSW
• Soana Palutea Fifita
• Kourtney Finch
• Hailey N Finn
• First Care Medical-Orthomed LLC (Excelsia Injury Care)
• Caroline M Fischer
• Natalie Fischetti

• Physician Assistant in Provo, UT
• Providers in Provo, UT by specialty
• Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2007; 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.