NPIMap

Organization Active NPI

Ihc Health Services, Inc.

Doing business as Lifestyle Medicine Wellness Center - Park City

  • Sports Medicine (Internal Medicine) Physician
  • Park City, UT
National Provider Identifier
1548727290
Registry record updated Jan 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Internal Medicine) PhysicianTaxonomy code 207RS0010X
Legal business name
IHC HEALTH SERVICES, INC.
Doing business as
Lifestyle Medicine Wellness Center - Park City
Practice address
900 Round Valley Dr Ste 110
Park City, UT 84060-7552
Phone
(435) 333-3535
NPI assigned
Feb 28, 2019
Last updated
Jan 31, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2024

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

Authorized official

Name
JP Valin, MD
Title
Chief Clinical Officer
Phone
(801) 442-2000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Internal Medicine) Physician 207RS0010X NU Primary
Occupational Medicine Physician 2083X0100X NU

Addresses

Primary practice location

900 Round Valley Dr Ste 110
Park City, UT 84060-7552

Mailing address

PO Box 27128
Salt Lake City, UT 84127-0128
Phone (435) 658-6703

Other names 1

  • Lifestyle Medicine Wellness Center - Park City Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080610000303 UT Part B Supplier - Clinic/Group Practice 1850209420 Receives reassigned benefits from 4,146 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
Robert E Fowles MD482 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1551312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706659200000",
    "number": "1548727290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27128",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841270128",
            "telephone_number": "435-658-6703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 ROUND VALLEY DR STE 110",
            "city": "PARK CITY",
            "state": "UT",
            "postal_code": "840607552",
            "telephone_number": "435-333-3535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IHC HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-28",
        "last_updated": "2024-01-31",
        "certification_date": "2024-01-31",
        "status": "A",
        "authorized_official_last_name": "VALIN",
        "authorized_official_first_name": "JP",
        "authorized_official_title_or_position": "CHIEF CLINICAL OFFICER",
        "authorized_official_telephone_number": "801-442-2000",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RS0010X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sports Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2083X0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lifestyle Medicine Wellness Center - Park City",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Park City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.