Individual provider Active NPI

Mitchell E. Allen, DO

  • Psychiatry Physician
  • Salt Lake City, UT
National Provider Identifier
1467155135
Registry record updated Sep 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
14130745-1204 Issued in UT
Practice address
501 S Chipeta Way
Salt Lake City, UT 84108-1222
Phone
(801) 581-7951
NPI assigned
Mar 22, 2023
Last updated
Sep 30, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 14130745-1204 UT Primary

Addresses

Primary practice location

501 S Chipeta Way
Salt Lake City, UT 84108-1222

Mailing address

501 S Chipeta Way
Salt Lake City, UT 84108-1222
Phone (801) 581-7951

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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
I20251202002870 ID Practitioner - Psychiatry 6204367709 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Rocky Vista University College of Osteopathic Med, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Idaho State UniversityGroup PAC ID 4688683030, 19 clinicians

Practice addresses (Care Compare)

421 Memorial Dr
Pocatello, ID 83201-4008
Phone (208) 282-2434

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Idaho State University CurrentSince Dec 1, 2025 Accepting new patients
Idaho State University Current Accepting new patients
Idaho State University CurrentSince Dec 1, 2025 Accepting new patients

Locations

1311 E Central Dr
Meridian, ID 83642
Phone (208) 373-1734

421 Memorial Dr
Pocatello, ID 83201
Phone (208) 234-7900

421 Memorial Dr
Bldg 82
Pocatello, ID 83201

990 Cesar Chavez Ave
Pocatello, ID 83209
Phone (208) 282-2330

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1679443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727654400000",
    "number": "1467155135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 S CHIPETA WAY",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841081222",
            "telephone_number": "801-581-7951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 S CHIPETA WAY",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841081222",
            "telephone_number": "801-581-7951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALLEN",
        "first_name": "MITCHELL",
        "middle_name": "E.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-22",
        "last_updated": "2024-09-30",
        "certification_date": "2024-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "UT",
            "license": "14130745-1204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.