Active NPI
Theresa Gourde, MD
- Internal Medicine Physician
- South Jordan, UT
National Provider Identifier
1487688685
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 111485-1205
- Practice address
- 10623 S Redwood Rd
Suite 101
South Jordan, UT 84095-2481 - Phone
- (801) 302-0899
- Fax
- (801) 302-0892
- NPI assigned
- Jul 11, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 111485-1205 | UT | Primary |
Addresses
Primary practice location
10623 S Redwood Rd
Suite 101
South Jordan, UT 84095-2481
Mailing address
10623 S Redwood Rd
Suite 101
South Jordan, UT 84095-2481
Phone (801) 302-0899
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 111485-1205 | Other | UT | MEDICAL LICENSE |
| 1447360383 | Medicaid | UT | |
| 1982871828 | Medicaid | UT |
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 Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lone Peak Primary Care LLC | Internal Medicine | Past | Accepting new patients |
| St. Mark'S South Jordan Family Practice LLC | 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.
-
- Internal Medicine Physician
- Sandy, UT
- NPI 1447360383
-
- Family Medicine Physician
- South Jordan, UT
- NPI 1982871828
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1270252800000",
"number": "1487688685",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10623 S REDWOOD RD",
"address_2": "SUITE 101",
"city": "SOUTH JORDAN",
"state": "UT",
"postal_code": "840952481",
"telephone_number": "801-302-0899",
"fax_number": "801-302-0892"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10623 S REDWOOD RD",
"address_2": "SUITE 101",
"city": "SOUTH JORDAN",
"state": "UT",
"postal_code": "840952481",
"telephone_number": "801-302-0899",
"fax_number": "801-302-0892"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOURDE",
"first_name": "THERESA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-11",
"last_updated": "2010-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "UT",
"license": "111485-1205",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL LICENSE",
"identifier": "111485-1205",
"state": "UT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1447360383",
"state": "UT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1982871828",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in South Jordan, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.