NPIMap

Organization Active NPI

ENT Surgical Associates PC

  • Otolaryngology Physician
  • Tooele, UT
National Provider Identifier
1598747768
Registry record updated Sep 10, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
58686931205 Issued in UT
Legal business name
ENT SURGICAL ASSOCIATES PC
Practice address
2376 North 400 East
Suite 202
Tooele, UT 84074
Phone
(435) 833-9600
NPI assigned
Nov 15, 2005
Last updated
Sep 10, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2009

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

Authorized official

Name
Peter Ventura, MDNPI 1144201690
Title
President
Phone
(435) 833-9600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 58686931205 UT Primary

Addresses

Primary practice location

2376 North 400 East
Suite 202
Tooele, UT 84074

Mailing address

2376 North 400 East
Suite 202
Tooele, UT 84074
Phone (435) 833-9600

Other identifiers 1

IdentifierTypeStateIssuer
529861509001MedicaidUT

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050729000866 UT Part B Supplier - Clinic/Group Practice 5799713871 Receives reassigned benefits from 3 practitioners
Practice locations: Tooele, UT

National Provider Directory

National Provider Directory
Tax ID family
ENT Surgical Associates2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

1244 N Main St
Ste 200
Tooele, UT 84074
Phone (435) 833-9600

Practitioners & affiliated clinicians

Practitioners 3

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": "1132012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1252540800000",
    "number": "1598747768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2376 NORTH 400 EAST",
            "address_2": "SUITE 202",
            "city": "TOOELE",
            "state": "UT",
            "postal_code": "84074",
            "telephone_number": "435-833-9600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2376 NORTH 400 EAST",
            "address_2": "SUITE 202",
            "city": "TOOELE",
            "state": "UT",
            "postal_code": "84074",
            "telephone_number": "435-833-9600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENT SURGICAL ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-15",
        "last_updated": "2009-09-10",
        "status": "A",
        "authorized_official_last_name": "VENTURA",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "435-833-9600",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "UT",
            "license": "58686931205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529861509001",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tooele, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2009; 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.