NPIMap

Individual provider Active NPI

Rebecca I. Tanner, MD

  • Internal Medicine Physician
  • Salt Lake City, UT
National Provider Identifier
1629050067
Registry record updated Sep 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
3258511205 Issued in UT
Practice address
1160 E 3900 S
Suite G200
Salt Lake City, UT 84124-1202
Phone
(801) 268-7766
NPI assigned
Nov 18, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 3258511205 UT Primary

Addresses

Primary practice location

1160 E 3900 S
Suite G200
Salt Lake City, UT 84124-1202

Mailing address

PO Box 271220
Salt Lake City, UT 84127-1220
Phone (801) 736-0110

Other identifiers 1

IdentifierTypeStateIssuer
PR67234MedicaidUT

Other names 1

  • Rebecca Irene Pollak Former name

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
I20041022000935 UT Practitioner - Internal Medicine 6709847072 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Arizona College of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Catholic Health Initiatives ColoradoGroup PAC ID 8022927342, 1,230 clinicians

Practice addresses (Care Compare)

3336 S 4155
Suite 306
West Valley City, UT 84120
Phone (901) 964-3855

Hospital & facility affiliations

  • Holy Cross Hospital - Salt Lake Hospital, Salt Lake City, UT, CCN 460003
  • Holy Cross Hospital-Jordan Valley Hospital, West Jordan, UT, CCN 460051
  • University of Utah Hospital and Clinics Hospital, Salt Lake City, UT, CCN 460009

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3258511205UTMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Catholic Health Initiatives Colorado CurrentSince May 1, 2023 Accepting new patients
Physician Group of Utah Inc CurrentSince Sep 1, 2012 Accepting new patients
Catholic Health Initiatives Colorado CurrentSince May 1, 2023 Accepting new patients
Catholic Health Initiatives Colorado Current Accepting new patients
Healthtrust Utah MGMT Services, Inc Internal Medicine Past Accepting new patients
Sunrise Medical Internal Medicine Past Accepting new patients
Stonebrook Medical L.L.C Past Accepting new patients
St Mark'S Professional Services, LLC Internal Medicine Past Accepting new patients
Catholic Health Initiatives Colorado Past Accepting new patients

Locations

82 S 1100 E
Ste 403
Salt Lake City, UT 84102
Phone (801) 364-1006

82 S 1100 E
Ste 103
Salt Lake Cty, UT 84102
Phone (801) 505-5370

2530 W 4700 S
Ste B8
Taylorsville, UT 84129
Phone (801) 967-5866

3580 W 90th S
West Jordan, UT 84088
Phone (801) 263-0810

Organizations & group practices 9

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 5

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": "1132272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1284508800000",
    "number": "1629050067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 271220",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841271220",
            "telephone_number": "801-736-0110",
            "fax_number": "801-366-9883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1160 E 3900 S",
            "address_2": "SUITE G200",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841241202",
            "telephone_number": "801-268-7766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANNER",
        "first_name": "REBECCA",
        "middle_name": "I.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-18",
        "last_updated": "2010-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "UT",
            "license": "3258511205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PR67234",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "REBECCA",
            "last_name": "POLLAK",
            "middle_name": "IRENE",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.