Individual provider Active NPI

Corey L Newman, PA-C

  • Physician Assistant
  • West Jordan, UT
National Provider Identifier
1629077870
Registry record updated Oct 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
372365-1206 Issued in UT
Practice address
7611 S Jordan Landing Blvd
Suite 200
West Jordan, UT 84084-5610
Phone
(801) 260-1919
Fax
(801) 260-1441
NPI assigned
Jul 19, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 372365-1206 UT Primary

Addresses

Primary practice location

7611 S Jordan Landing Blvd
Suite 200
West Jordan, UT 84084-5610

Mailing address

7611 S Jordan Landing Blvd
Suite 200
West Jordan, UT 84084-5610
Phone (801) 260-1919

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041119000146 UT Practitioner - Physician Assistant 1456315308 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
After Hours Medical LLC, Dba Medallus Medical CurrentSince Oct 1, 2007 Accepting new patients
After Hours Medical LLC, Dba Medallus Medical CurrentSince Oct 1, 2007 Accepting new patients
After Hours Medical LLC Past Accepting new patients
Utah Valley Radiology Associates Inc PastSince May 1, 2008 Accepting new patients
Direct Care Medical Home Clinic LLC Past Accepting new patients

Locations

1126 E Draper Pkwy
Draper, UT 84020
Phone (801) 545-0600

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1121731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1351123200000",
    "number": "1629077870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7611 S JORDAN LANDING BLVD",
            "address_2": "SUITE 200",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840845610",
            "telephone_number": "801-260-1919",
            "fax_number": "801-260-1441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7611 S JORDAN LANDING BLVD",
            "address_2": "SUITE 200",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840845610",
            "telephone_number": "801-260-1919",
            "fax_number": "801-260-1441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEWMAN",
        "first_name": "COREY",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-19",
        "last_updated": "2012-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "372365-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Jordan, UT

Sources for this page

Verify at the official NPI Registry.