Individual provider Active NPI

Donna Mathis, FNP

  • Family Nurse Practitioner
  • Price, UT
National Provider Identifier
1467454413
Registry record updated May 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2094274405 Issued in UT
Practice address
280 N Hospital Dr
Ste 3
Price, UT 84501-4216
Phone
(435) 637-6348
Fax
(435) 637-6422
NPI assigned
Jun 2, 2005
Last updated
May 14, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 14, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 2094274405 UT Primary

Addresses

Primary practice location

280 N Hospital Dr
Ste 3
Price, UT 84501-4216

Mailing address

280 N Hospital Dr
Suite 3
Price, UT 84501-4216
Phone (435) 637-6348

Other identifiers 1

IdentifierTypeStateIssuer
DD8580OtherUTPALMETTO GBA- RAILROAD MEDICARE

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20031112000776 UT Practitioner - Nurse Practitioner 4082528294 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shane D Gagon MD, PCGroup PAC ID 9335236868, 9 clinicians

Practice addresses (Care Compare)

377 No Fairgrounds Rd
Gagon Family Practice
Price, UT 84501-4211
Phone (435) 613-2200

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2094274405UTMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Shane D Gagon MD, PC CurrentSince Oct 1, 2015 Accepting new patients

Locations

377 N Fairgrounds Rd
Price, UT 84501
Phone (435) 613-2200

Organizations & group practices 1

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1117670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210723200000",
    "number": "1467454413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "280 N HOSPITAL DR",
            "address_2": "SUITE 3",
            "city": "PRICE",
            "state": "UT",
            "postal_code": "845014216",
            "telephone_number": "435-637-6348",
            "fax_number": "435-637-6422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "280 N HOSPITAL DR",
            "address_2": "STE 3",
            "city": "PRICE",
            "state": "UT",
            "postal_code": "845014216",
            "telephone_number": "435-637-6348",
            "fax_number": "435-637-6422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHIS",
        "first_name": "DONNA",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-02",
        "last_updated": "2008-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "UT",
            "license": "2094274405",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA- RAILROAD MEDICARE",
            "identifier": "DD8580",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Price, UT

Sources for this page

Verify at the official NPI Registry.