Individual provider Active NPI

Tom Rieber

  • Nurse Practitioner
  • Millcreek, UT
National Provider Identifier
1477228427
Registry record updated Mar 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
9754454-8900 Issued in UT
Practice address
1200 E 3900 S
Millcreek, UT 84124-1300
Phone
(801) 268-7111
NPI assigned
Aug 11, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 9754454-8900 UT Primary

Addresses

Primary practice location

1200 E 3900 S
Millcreek, UT 84124-1300

Mailing address

2841 E 2100 S
Salt Lake City, UT 84109-1446
Phone (310) 403-9493

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
I20211220000120 UT Practitioner - Nurse Practitioner 2365833761 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Intensive Care Consortium IncGroup PAC ID 0244269413, 485 clinicians

Practice addresses (Care Compare)

1200 E 3900
Salt Lake City, UT 84124-1300
Phone (561) 997-0821

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9754454-8900UTMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Intensive Care Consortium Inc Nurse Practitioner CurrentSince Oct 6, 2021 Accepting new patients

Locations

2000 Health Park Dr
Brentwood, TN 37027
Phone (615) 372-5426

1200 E 3900 S
Slc, UT 84124
Phone (801) 268-7111

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 and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1628640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647993600000",
    "number": "1477228427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2841 E 2100 S",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841091446",
            "telephone_number": "310-403-9493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 E 3900 S",
            "city": "MILLCREEK",
            "state": "UT",
            "postal_code": "841241300",
            "telephone_number": "801-268-7111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIEBER",
        "first_name": "TOM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-11",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "UT",
            "license": "9754454-8900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Millcreek, UT

Sources for this page

Verify at the official NPI Registry.