Tooele Urology LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

7100427-1205 Issued in UT

Legal business name

TOOELE UROLOGY LLC

Practice address

11179 Ivy Creek CV
South Jordan, UT 84095-2249

Phone

(801) 822-2727

NPI assigned

Jan 21, 2009

Organization subpart

Yes

Parent organization

UROLOGIC SURGERY ASSOCIATESAs reported in NPPES

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

Authorized official

Name

Dr. Dan Hibbert, MD

Title

Manager

Phone

(801) 822-2727

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Part of

Urologic Surgery Associates

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Urologic Surgery Associates

  • Medical Specialty Clinic/Center
  • South Jordan, UT
  • NPI 1588802961
  NPPES parent name

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Joshua David Holyoak, M.D.

  • Urology Physician
  • West Jordan, UT
  • NPI 1407071665
  Medicare reassignment Care Compare group NPD
• Gary Blake Johnson, MD

  • Urology Physician
  • Salt Lake City, UT
  • NPI 1144223827
  Medicare reassignment Care Compare group NPD
• Curtis D Niederhauser, PA-C

  • Surgical Physician Assistant
  • West Valley City, UT
  • NPI 1396909594
  Medicare reassignment Care Compare group
• Daniel L Hibbert, MD

  • Urology Physician
  • Tooele, UT
  • NPI 1275647562
  Medicare reassignment NPD
• Justin Paul Parkinson, MD

  • Urology Physician
  • Bountiful, UT
  • NPI 1851314066
  Medicare reassignment NPD
• Samuel James Otto, M.D.

  • Urology Physician
  • Milwaukee, WI
  • NPI 1154565273

  UT

  Medicare reassignment NPD

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

{
    "created_epoch": "1232496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569369600000",
    "number": "1457599912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11179 IVY CREEK CV",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840952249",
            "telephone_number": "801-822-2727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11179 IVY CREEK CV",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840952249",
            "telephone_number": "801-822-2727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOOELE UROLOGY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "UROLOGIC SURGERY ASSOCIATES",
        "enumeration_date": "2009-01-21",
        "last_updated": "2019-09-25",
        "status": "A",
        "authorized_official_last_name": "HIBBERT",
        "authorized_official_first_name": "DAN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "801-822-2727",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QL0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Lithotripsy",
            "state": "UT",
            "license": "7100427-1205",
            "primary": false
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "UT",
            "license": "7100427-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Michelle Tonga
• Tradewinds Counseling
• Brittany Tran, PA-C
• Phung Tran
• Trenaisa Nay Consulting, LLC
• Jayme Erika Trevino, MD

• Medical Specialty Clinic/Center in South Jordan, UT
• Providers in South Jordan, UT by specialty
• Medical Specialty Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.