NPIMap

Organization Active NPI

Personal Performance Medical Corporation

  • Prosthetic/Orthotic Supplier
  • Midvale, UT
National Provider Identifier
1528041662
Registry record updated Jul 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
License
19793280 Issued in UT
Legal business name
PERSONAL PERFORMANCE MEDICAL CORPORATION
Practice address
7575 S 900 E
Midvale, UT 84047-2343
Phone
(801) 364-3100
Fax
(801) 872-5714
NPI assigned
Nov 22, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2024

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

Authorized official

Name
Mr. Scott E Allen, CERTIFIED PROSTHETIS
Title
Owner
Phone
(801) 364-3100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthetic/Orthotic Supplier 335E00000X 19793280 UT Primary

Addresses

Primary practice location

7575 S 900 E
Midvale, UT 84047-2343

Mailing address

7575 S 900 E
Midvale, UT 84047-2343
Phone (801) 364-3100

Other names 1

  • Fit-Well Prosthetic & Orthotic Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930001124 UT DME Supplier - Orthotic PersonnelDME Supplier - Prosthetic Personnel 1355468059 Practice locations: Midvale, UT

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Fit-Well Prosthetic & Orthotic Cent7575 S 900 E, Midvale, UT 84047-2343801364310014 Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Limb Prostheses|Diabetic Shoes and Inserts|Diabetic Shoes/Inserts - Custom|Lymphedema Compression Treatment Items Does not accept assignmentParticipating since Jan 1, 1998

National Provider Directory

National Provider Directory
Tax ID family
Fit-Well Pros Orth CN3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1132617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720137600000",
    "number": "1528041662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7575 S 900 E",
            "city": "MIDVALE",
            "state": "UT",
            "postal_code": "840472343",
            "telephone_number": "801-364-3100",
            "fax_number": "801-872-5714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7575 S 900 E",
            "city": "MIDVALE",
            "state": "UT",
            "postal_code": "840472343",
            "telephone_number": "801-364-3100",
            "fax_number": "801-872-5714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERSONAL PERFORMANCE MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-22",
        "last_updated": "2024-07-05",
        "certification_date": "2024-07-05",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-364-3100",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CERTIFIED PROSTHETIS"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "UT",
            "license": "19793280",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fit-Well Prosthetic & Orthotic Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fit-Well Prosthetic & Orthotic Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Midvale, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.