Fatima Gangotena-Bernard, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

7748728-1205 Issued in UT

Practice address

144 S 500 E
Salt Lake City, UT 84102-1907

Phone

(801) 783-5011

NPI assigned

Oct 28, 2008

Last updated

Sep 1, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Fatima Gangotena Former name

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Beaver Valley Hospital

  dba Copper Ridge Health Care

  • Skilled Nursing Facility
  • West Jordan, UT
  • NPI 1235682519

  Adp of the SNF, Managing Control - Governing Body, Operational/Managerial Control

  CMS ownership
• Beaver Valley Hospital

  dba St. Joseph Villa

  • Skilled Nursing Facility
  • Salt Lake City, UT
  • NPI 1477007524

  Adp of the SNF, Managing Control - Governing Body, Operational/Managerial Control

  CMS ownership
• Gunnison Valley Hospital

  dba Monument Healthcare Taylorsville

  • Skilled Nursing Facility
  • Salt Lake City, UT
  • NPI 1134610249

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Gunnison Valley Hospital

  dba Monument Healthcare Murray Creek

  • Skilled Nursing Facility
  • Salt Lake City, UT
  • NPI 1174014286

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Gunnison Valley Hospital

  dba Meadow Peak Rehabilitation

  • Skilled Nursing Facility
  • Taylorsville, UT
  • NPI 1548013352

  Adp of the SNF

  CMS ownership

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.

• Santibanez Pac Utah

  • Geriatric Medicine (Internal Medicine) Physician
  • Salt Lake City, UT
  • NPI 1881469484
  Medicare reassignment NPD
• Utah Regional Hospitalists LLC

  • Hospitalist Physician
  • Murray, UT
  • NPI 1962821223
  Medicare reassignment NPD
• Post Acute Medical PLLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Lanham, MD
  • NPI 1730713025

  UT

  Medicare reassignment NPD
• Utah Regional Hospitalists LLC

  dba Utah Regional Hospitalists

  • Hospitalist Physician
  • Idaho Falls, ID
  • NPI 1740715507
  NPD

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

{
    "created_epoch": "1225152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472688000000",
    "number": "1467605147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "144 S 500 E",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841021907",
            "telephone_number": "801-783-5011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "144 S 500 E",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841021907",
            "telephone_number": "801-783-5011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANGOTENA-BERNARD",
        "first_name": "FATIMA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-28",
        "last_updated": "2016-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "UT",
            "license": "7748728-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "FATIMA",
            "last_name": "GANGOTENA",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Amanda Dawn Gammon, M.S., CGC
• Daniel Stoel Gammon, M.D.
• Edward W Ganellen, MD
• Kajal Kalpana Ganesh
• Luke Anthony Gangi Wellman
• Kailee S Ganir
• Nadia M Ganom
• Charlotte Elaine Gant, M.D.
• Eduard Gappmaier, PT, PHD
• Daniel Gappmayer

• Internal Medicine Physician in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Internal Medicine Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.