NPIMap

Individual provider Active NPI

Kevin Mangum, D.O.

  • Sports Medicine (Family Medicine) Physician
  • Murray, UT
National Provider Identifier
1609140847
Registry record updated Jun 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
8164477-1204 Issued in UT
Practice address
6095 S Fashion Blvd Ste 220
Murray, UT 84107-7393
Phone
(801) 758-8735
Fax
(801) 769-2092
NPI assigned
Mar 6, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 8164477-1204 UT
Sports Medicine (Family Medicine) Physician 207QS0010X 8164477-1204 UT Primary

Addresses

Primary practice location

6095 S Fashion Blvd Ste 220
Murray, UT 84107-7393

Mailing address

6095 S Fashion Blvd Ste 220
Murray, UT 84107-7393
Phone (801) 758-8735

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address KMANGUM577566@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
I20210813003052 UT Practitioner - Family PracticePractitioner - Sports Medicine 2961825641 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Sports Medicine
Education
At Still Un of HLTH Sciences, Col of Osteo Med, Mesa, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Primary Healthcare, PLLCGroup PAC ID 5092187617, 3 clinicians

Practice addresses (Care Compare)

6360 S 3000
Suite 210
Cottonwood Heights, UT 84121-6972
Phone (435) 615-8822

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Community Physicians Group Family Medicine CurrentSince Dec 1, 2022 Accepting new patients
University of Utah Community Physicians Group Family Medicine Current Accepting new patients
University of Utah Community Physicians Group CurrentSince Dec 1, 2022 Accepting new patients
Utah Sports and Orthopedics Sports Medicine Current Accepting new patients
Primary Healthcare, PLLC Family Medicine CurrentSince Feb 1, 2023 Accepting new patients
Mountain West Medical Equipment Current Accepting new patients

Locations

6095 S Fashion Blvd
Ste 220
Salt Lake City, UT 84107
Phone (801) 268-4986

1525 W 2100 S
Salt Lake City, UT 84119
Phone (801) 213-8841

6360 S 3000 E
Ste 210
Salt Lake Cty, UT 84121
Phone (435) 615-8822

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

Interoperability endpoints

  • Direct secure messaging: kmangum577566@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 7

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": "1330992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687132800000",
    "number": "1609140847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6095 S FASHION BLVD STE 220",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841077393",
            "telephone_number": "801-758-8735",
            "fax_number": "801-769-2092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6095 S FASHION BLVD STE 220",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841077393",
            "telephone_number": "801-758-8735",
            "fax_number": "801-769-2092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGUM",
        "first_name": "KEVIN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-03-06",
        "last_updated": "2023-06-19",
        "certification_date": "2023-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "8164477-1204",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "UT",
            "license": "8164477-1204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "KMANGUM577566@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": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Murray, UT

Sources for this page

Verify at the official NPI Registry.