Active NPI
Gary Lee Groom, PHD
- Psychologist
- St George, UT
National Provider Identifier
1467404202
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1136132501
- Practice address
- 1424 E Foremaster Dr
Suite 120
St George, UT 84790-6326 - Phone
- (435) 656-8800
- Fax
- (435) 627-1809
- NPI assigned
- May 17, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1136132501 | UT | Primary |
Addresses
Primary practice location
1424 E Foremaster Dr
Suite 120
St George, UT 84790-6326
Mailing address
PO Box 727
Brigham, UT 84302
Phone (435) 734-0101
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1136132501 | UT | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hu Ding, M.D., P.C. | Past | Accepting new patients | |
| Anatomic Pathology Associates | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Anatomic Pathology & Clinical Pathology Physician
- Salt Lake City, UT
- NPI 1558441485
-
- Anatomic Pathology & Clinical Pathology Physician
- Bountiful, UT
- NPI 1740436625
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1195084800000",
"number": "1467404202",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 727",
"city": "BRIGHAM",
"state": "UT",
"postal_code": "84302",
"telephone_number": "435-734-0101",
"fax_number": "435-734-0103"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1424 E FOREMASTER DR",
"address_2": "SUITE 120",
"city": "ST GEORGE",
"state": "UT",
"postal_code": "847906326",
"telephone_number": "435-656-8800",
"fax_number": "435-627-1809"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GROOM",
"first_name": "GARY",
"middle_name": "LEE",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-17",
"last_updated": "2007-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "UT",
"license": "1136132501",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St George, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.