NPIMap

Individual provider Active NPI

Charles Blair Stillerman, M.D., F.A.C.S.

  • Neurological Surgery Physician
  • Salt Lake City, UT
National Provider Identifier
1477628667
Registry record updated Feb 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
6059746-1205 Issued in UT
Practice address
175 N Medical Dr
Salt Lake City, UT 84132-6967
Phone
(801) 581-6908
Fax
(801) 581-4385
NPI assigned
Nov 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X 6059746-1205 UT Primary

Addresses

Primary practice location

175 N Medical Dr
Salt Lake City, UT 84132-6967

Mailing address

175 N Medical Dr
Salt Lake City, UT 84112-1103
Phone (801) 581-6908

Other identifiers 1

IdentifierTypeStateIssuer
0289043MedicaidNJ

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cstillerman515808@direct.med.utah.edu Direct University of Utah

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210514000842 UT Practitioner - Neurosurgery 8921140872 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
Loyola University of Chicago, Stritch School of Medicine, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

50 N Medical Dr
Salt Lake City, UT 84132-0100
Phone (801) 581-2121

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.06 of 100Reported as group
Quality
77.8
Promoting interoperability
100
Improvement activities
40
Cost
65.74

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion94
Laminectomy or laminotomy (partial removal of spine bones)50

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
6059746-1205UTMDNeurological Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Surgical Services Neurological Surgery CurrentSince Apr 7, 2021 Accepting new patients
University of Utah Acuity Care Services CurrentSince Apr 7, 2021 Accepting new patients
University of Utah Acuity Care Services CurrentSince Apr 7, 2021 Accepting new patients
University of Utah Surgical Services CurrentSince Apr 7, 2021 Accepting new patients
University of Utah Surgical Services Current Accepting new patients
University of Utah Acuity Care Services Current Accepting new patients
Frances Mahon Deaconess Hospital Past Accepting new patients

Locations

250 E 200 S
Ste 1350
Salt Lake City, UT 84111
Phone 80158763362003

175 N Medical Dr
#U
Salt Lake City, UT 84112
Phone (801) 585-7575

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

175 N Medical Dr
Slc, UT 84112
Phone (801) 581-6908

Interoperability endpoints

  • Direct secure messaging: cstillerman515808@direct.med.utah.edu

Organizations & group practices 7

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 5

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": "1164153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740614400000",
    "number": "1477628667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 N MEDICAL DR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841121103",
            "telephone_number": "801-581-6908",
            "fax_number": "801-581-4385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 N MEDICAL DR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841326967",
            "telephone_number": "801-581-6908",
            "fax_number": "801-581-4385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STILLERMAN",
        "first_name": "CHARLES",
        "middle_name": "BLAIR",
        "credential": "M.D., F.A.C.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-22",
        "last_updated": "2025-02-27",
        "certification_date": "2025-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "UT",
            "license": "6059746-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0289043",
            "state": "NJ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cstillerman515808@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.