NPIMap

Organization Active NPI

Utah Podiatry Group PC

  • Foot & Ankle Surgery Podiatrist
  • Provo, UT
National Provider Identifier
1457737579
Registry record updated Apr 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
Legal business name
UTAH PODIATRY GROUP PC
Practice address
1973 North State Street
Provo, UT 84604-1012
Phone
(801) 373-2499
Fax
(801) 373-5200
NPI assigned
Jul 31, 2015
Organization subpart
Yes
Parent organization
UTAH PODIATRY GROUP PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 21, 2020

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

Authorized official

Name
Susan Marie Taylor
Title
Director of Operations
Phone
(801) 505-0821

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0103X Primary

Addresses

Primary practice location

1973 North State Street
Provo, UT 84604-1012

Mailing address

PO Box 30015 Dept 380
Salt Lake City, UT 84130-0015
Phone (801) 373-2499

Other identifiers 1

IdentifierTypeStateIssuer
6152070001OtherUTDME PTAN

Other names 1

  • Advanced Foot & Ankle Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080530000369 UT Part B Supplier - Clinic/Group Practice 2163592379 Receives reassigned benefits from 15 practitioners
19 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Park City, UT; West Jordan, UT; South Ogden, UT; Sandy, UT; Salt Lake City, UT; Millcreek, UT; Highland, UT; Heber City, UT…

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Utah Podiary Group PC

NPI Registry JSON

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

{
    "created_epoch": "1438300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587427200000",
    "number": "1457737579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30015 DEPT 380",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841300015",
            "telephone_number": "801-373-2499",
            "fax_number": "801-373-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1973 NORTH STATE STREET",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846041012",
            "telephone_number": "801-373-2499",
            "fax_number": "801-373-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UTAH PODIATRY GROUP PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "UTAH PODIATRY GROUP PC",
        "enumeration_date": "2015-07-31",
        "last_updated": "2020-04-21",
        "certification_date": "2020-04-21",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "801-505-0821"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME PTAN",
            "identifier": "6152070001",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Foot & Ankle Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Advanced Foot & Ankle Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Provo, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2020; 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.